不同诱导方法对小儿OSAS手术麻醉效果的比较

Comparison of the Effect of Different Revulusion Methods for the Children Patients with OSAS Surgery

目的比较不同诱导方法对小儿阻塞性睡眠呼吸暂停综合征的麻醉效果。方法60例5～12岁的患儿随机分为瑞芬太尼丙泊酚诱导组(R组)和氯胺酮诱导组(K组),麻醉维持用药相同,为丙泊酚5mg(/kg·h)、瑞芬太尼0.5～1.0μg(/kg·min)持续泵注。术中根据患儿或手术情况调节静脉输注速度,分次追加维库溴铵0.05mg/kg,维持循环稳定。记录患儿术毕自主呼吸恢复时间、气管导管拔除时间、停药至完全清醒时间、苏醒期躁动以及PACU逗留时间。结果R组诱导后血压、心率有所下降,使用了阿托品治疗后,R组没有出现血压、心率下降的情况。两组患儿在整个手术过程中血流动力学稳定。手术结束,R组自主呼吸恢复时间、拔管时间、睁眼时间、PACU逗留时间均明显少于K组(P<0.05)。K组苏醒时呛咳发生率明显高于R组(P<0.01),明显不利于患者的恢复。结论瑞芬太尼复合丙泊酚静脉麻醉深度可以控制,术毕苏醒迅速、完善、安全,并发症少,较氯胺酮有明显的优点,能更加安全的用于小儿阻塞性睡眠呼吸暂停综合征的手术麻醉。

Objective To compare the anesthesia effect of different revulusion methods for the children patients undergoing（OSAS）surgery, Methods Total 60 patients （5-12 years old） were randomized into two groups with 30 cases in remifentanil and propfol revulusion group （R）, and 30 cases in ketanine revulusion group （K）. The preserved drugs were the same ： propofol was given at a dose of 5mg/（kg· h）, and remifentanil was given at a dose of 0.5-1.0 μg/（ kg·min ） in continous influsion. To adjust the pumping speed with the condition of patients and surgery during the operation. To add the vecuronium with 0.05mg/kg to keep banlance of circulation. Write down the time when the patients＇ breathe recovered, the time of tracheal extubation, emergence time, the frequency of moving restlessly when waked and the time in the PACU. Results In group R, the BP and HR declined after revulusion, need use atropine. In group K the BP and HR were smooth. The circulation of the two groups were all smooth during the operation. In the end of operation, the time when the patients＇ breathe recovered ,the time of tracheal extubation,emergence time, the frequency of moving restlessly when waked and the time in the PACU of group R were evidently shorter than group K（ P〈 0.05 ）. In group K,the frequency of choke was evidently more than group R（ P 〈 0.01 ）,which was much harmful for the patients＇recovery. Conclusion In group R the anesthesia depth can be controlled,also waking speedly,perfectly and safe,few comphcation. Group R is evidently better than group K,so it can be used in the anesthesia for the children patients undergoing OSAS surgery.