瑞芬太尼全麻用于儿童经食管超声心动图引导介入性房间隔缺损封堵术的临床研究

Clinical study on general anesthesia with remifentanil during pediatric cardiac catheterization with occlusion of secundum atrial septal defect undergoing transesophageal echocardiography

目的观察瑞芬太尼、芬太尼泵注全麻用于儿童经食管超声心动图引导介入性房间隔缺损封堵术的可行性和临床效果。方法选择ASAⅠ～Ⅱ级,经食管超声心动图引导介入性房间隔缺损封堵术患儿40例,随机分为RF、F2组,每组20例,分别以瑞芬太尼泵注及芬太尼静脉注射诱导及维持麻醉,术中分别观测并比较2组患儿血流动力学变化及术毕患儿清醒拔管时间,并观测术中不良反应如体动反应、心动过缓的发生,以及术后的不良反应如喉痉挛、呼吸抑制等。结果诱导时的平均动脉压,诱导时、气管插管和气管拔管时的心率,RF组均明显低于F组(P<0.05)。睁眼时间、拔管时间RF组明显短于F组(P<0.05)。结论与丙泊酚-芬太尼静脉复合麻醉相比,丙泊酚-瑞芬太尼静脉复合麻醉苏醒更加迅速,能更好地控制术中血压变化。瑞芬太尼泵注全身麻醉用于儿童经食管超声心动图引导介入性房间隔缺损封堵术可行且安全有效。

Objective To do a comparative study on the feasibility and validity of using remifentanil and fentanyl in general anaesthesia during pediatric cardiac catheterization with occlusion of secundum atrial septal defect undergoing transesophageal echocardiography. Methods 40 ASA class Ⅰ-Ⅱ children undergoing cardiac catheteriza tion with occlusion of seeundum atrial septal defect undergoing transesophageal echocardiography were randomly divided into two groups：fentanyl group（group F） and remifentanil group（ group RF）, 20 cases in each group. In group RF, analgesia was induced and maintained with infusion remifentanil, In group F, analgesia was induced and maintained with fentanyl infusion. In both groups, heart rate and blood pressure were recorded at baseline, anesthesia induction, tracheal intubation, tracheal intubaion and time of extubation were recorded. The complications during anaesthesia were observed, including physical mobile and arrhythmias, and laryngospasm, difficulties of self ventilation and adverse effects were observed. Results Mean arterial pressure and heart rate during induction, intubation and extubation in group RF were significantly shorter than those in group F （P〈0.05）. The time of lasting intubation and losing consciousness was in group RF was significantly shorter than that in group F（P〈0.05）. Conclusion AS compared with fentanyl plus propofol, remifentanil plus propofol could lead to rapid recovery of consciousness from anesthesia, good control of hemodynamic rsponses. Using remifentanil in general anaesthesia during pediatric cardiac catheterization with occlusion of secundum atrial septal defect undergoing transesophageal echocardiography is a safe and effective method.