眼科手术患儿瑞芬太尼复合异丙酚麻醉的效果

Efficacy of remifentanil combined with propofol in children undergoing ophthaimologic operation

目的 探讨眼科手术患儿瑞芬太尼复合异丙酚麻醉的效果。方法 择期行眼科短小手术患儿48例，年龄4～12岁，按年龄和麻醉药物分为4组（n=12）：ⅠPK组4～7岁，氯胺酮复合异丙酚麻醉；ⅠPR组4～7岁，瑞芬太尼复合异丙酚麻醉；ⅡPK组8～12岁，氯胺酮复合异丙酚麻醉；ⅡPR组8～12岁，瑞芬太尼复合异丙酚麻醉。ⅠPK组和ⅡPK组静脉注射氯胺酮2mg／kg和异丙酚2mg／kg麻醉诱导，静脉输注异丙酚6mg·kg^-1·h^-1及间断静脉注射氯胺酮1～2mg／kg维持麻醉。ⅠPR组和ⅡPR组静脉注射瑞芬太尼1／2g／kg和异丙酚2mg／kg麻醉诱导；麻醉维持：静脉输注异丙酚6mg·kg^-1·h^-1和瑞芬太尼0．1μg·kg^-1·min^-1，瑞芬太尼每2分钟增加0．025μg·kg^-1·min^-1，直至0．2μg·kg^-1·min^-1。于麻醉诱导前、麻醉诱导后冲洗眼球时、手术开始后即刻、手术开始后15min和出手术室时，记录收缩压（SP）、舒张压（DP）、心率（HR）、呼吸频率（RR）、脉搏血氧饱和度和麻醉深度指数（CSI）。记录术中和术后不良反应的发生情况。记录麻醉诱导时间、苏醒时间、意识恢复时间和总镇静时间。计算瑞芬太尼平均输注速率。结果与麻醉诱导前比较，4组SP、DP、HR、RR和CSI均降低（P〈0．05）；与ⅠPK组和ⅡPK组比较，ⅠPR组和ⅡPR组RR和CSI降低，术中体动和术后躁动发生率降低，麻醉诱导时间延长，苏醒时间和意识恢复时间缩短（P〈0．05）；与ⅠPR组比较，ⅡPR组麻醉诱导时间和意识恢复时间缩短（P〈0．05）。ⅡPR组瑞芬太尼平均输注速率小于ⅠPR组（P〈0．05）。结论 瑞芬太尼复合异丙酚用于眼科短小手术患儿麻醉可产生良好的麻醉效果，且血液动力学平稳，不良反应少，术后苏醒迅速，而不同年龄患儿瑞芬太尼用量不同。

Objective To evaluate the efficacy of renfifentanil combined with propofol in children of different age undergoing short-term ophthalmologic operation. Methods Forty-eight children aged 4-12 yr undergoing elective short-term ophthalmologic operation were divided into 4 groups （ n = 12 each） according to age and anesthetics： group ⅠPK aged 4-7 yr and group ⅡPK aged 8-12 yr received ketamine and propofol combined anesthesia; group ⅠPR aged 4-7 yr and group Ⅱ PR aged 8-12 yr received remifentanil and propofol combined anesthesia. In group Ⅰ PK and Ⅱ PK the anesthesia was induced with intravenous bolus of ketamine 2 mg/kg and pmpofol 2 mg/kg and maintained with intravenous infusion of propofol 6mg· kg^-1· h^- 1 and intermittent bolus of ketamine 1-2 mg/kg. In group Ⅰ PR and Ⅱ PR the anesthesia was induced with intravenous remifentanil 1μg/kg and propofol 2 mg/kg and maintained with intravenous infusion of propofol 6 mg· kg^- 1 · h^- 1 and renfifentanil, the initial infusion rate of remifentanil was set at 0.1 μg·kg^-1·min^-1 followed by increments of 0. 025 μg· kg^- 1· min^-1 every 2 rain until reaching 0.2 μg· kg^- 1· min^- 1. Systolic blood pressure （ SP）, diastolic blood pressure （ DP）, HR, respiratory rate （RR）, cerebral state index （CSI） and SpO2 were recorded before anesthesia induction（baseline）, 2 nfin after induction, at the initiation of the operation, 15 min after the initiation of operation and at emergence from anesthesia. Adverse effects during and after the operation, induction time, analepsia time, conscious recovery time and total sedation time were recorded. The mean infusion rate of remifentanil was calculated. Results Compared with the baesline, SP, DP, HR,RR and CSI were significantly decreased in 4 groups（ P 〈 0.05）. RR, CSI and incidence rates of adverse effects were significantly lower, and the emergence time and the recovery time of consciousness were significantly shorter in group Ⅰ PR and Ⅱ PR than in group Ⅰ PK and ⅡPK （ P 〈 0.05 ） . The average infusion rate of remifentanil was lower in group Ⅱ PR than in group ⅠPR （P 〈 0.05）. Conclusion Remifentanil combined with propofol can produce good anesthetic effect in children undergoing short-term ophthalmologic operation, with less adverse effects, stable hemodynamics and rapid emergence from anesthesia. The dosage of remifentanil is different in children at different ages.