雷米芬太尼复合丙泊酚静脉麻醉用于小儿气管异物取出术

Application of remifentanil combined with propofol intravenous anesthenia for extripation of children brocherextraneous

目的研究比较雷米芬太尼复合丙泊酚静脉麻醉应用于小儿气管异物取出术的麻醉效果及安全性。方法选择48例气管异物患儿,随机分为A组（24例）和B组（24例）,两组均静脉注射丙泊酚1~1.5 mg/kg后以80~150μg.kg-1.min-1速率持续输注。A组静脉注射雷米芬太尼后持续输注;B组靶控输注（TCI）。术中用KR-III（B）喷射呼吸机经支气管镜侧孔行高频喷射通气（HFJV）。术中增减雷米芬太尼用量调节麻醉深度。观察记录入室后、注射丙泊酚后2分钟、注射雷米芬太尼2分钟、置入支气管镜时、取异物时、术毕5分钟时点MAP、HR、SpO2、RR值;记录术中呛咳挣扎、喉痉挛、呼吸抑制、肌强直、心动过缓和术后恶心呕吐等发生率和术毕清醒时间、雷米芬太尼和丙泊酚用量。结果注射雷米芬太尼后SBP、HR A组较B组下降明显,在置镜、异物取出时A组较B组升高明显,雷米芬太尼用量A组明显多于B组,差异有统计学意义（P〈0.05）。A组有8例患儿出现呼吸抑制,B组2例;A组有5例患儿出现呛咳屏气,B组有1例。结论雷米芬太尼靶控输注较持续输注靶复合丙泊酚全凭静脉麻醉用于小儿异物取出术,患儿术中生命体征更平稳,能保留患儿自主呼吸,术毕清醒迅速。

Objectlve：To research and compare the anesthetic effect and safety of remifentanll combined with propofol intravenous anesthenia for this operation. Methods： Forty -eight brocherextrancous children patients were randomized into A group and B group. All patients were given propofol 1 -1.5 mg/Kg for bolus injection and then 80 -150μg/（ Kg·min^-1 ） for continual infusion. A group was given remifentanil for bolus injection and then continual infusion. B group were given remifentanil for TCL In operation, use KR -Ⅲ（B） splint life -support machine for HFJV through the outlet of the bronchoscope, and regulate anesthetic depth by increasing the dosage of remifentanil. MAP, HR, SpO2, RR,the confidence rate of cough, struggle, largugismus respiratory repression, myotonia, bradyrhythmia and nausea vomit, recovery time, the dosage of remifentanil and prepofol were recorded. Results： After injecting remifentanil, the SBP and HR in A group decreased more significantly than those in B group. During posting bronchoscope and taking out extraneous, the values in A group increased mour significantly than those in B group. The dosage of remifentanil in A group is mour significantly than that in B group. There were significant differences between two groups. Conclusion： The physical sign of children patients in operation was more steady with remifentanil TCI than with continual remifentanll combined with propofol infusion for extirpation of children extiancous. The former can maintain patients autonomous respiration patients recovered rapidly after operation