七氟醚与异丙酚在小儿心脏手术全麻诱导中作用的比较

Comparison of Induction with Sevoflurane and Propofol in Children Heart Surgery

目的：研究七氟醚快速吸入麻醉诱导与异丙酚静脉麻醉诱导两种方法在小儿心脏手术中的应用。方法：选择先天性心脏病患儿60例,ASAⅡ级,年龄1.5-12岁,随机分成七氟醚吸入诱导组（Sev组,n=30）和异丙酚静脉诱导组（Pro组,n=30）。记录两组从诱导开始至意识消失时间（睫毛反射消失）,插管时间,有无插管反应（呛咳、屏气、喉痉挛及支气管痉挛）,记录诱导前、诱导后、插管即时和插管后2m in各时间点的HR、SpO2%及MAP变化,用方差分析和t检验进行统计学的分析。结果：（1）Pro组意识消失时间和插管时间较Sev组显著缩短（P〈0.01）,两组均未有呛咳、屏气、喉痉挛及支气管痉挛的发生。（2）Pro组诱导后和插管时的MAP与诱导前比较有显著性差异（P〈0.05）。Pro组与Sev组在诱导后、插管时MAP比较有显著性差异（P〈0.05）。（3）两组诱导后的HR与诱导前比较有显著性差异（P〈0.05）,但组间差异无显著性,Pro组插管时HR与诱导前比较有显著性差异（P〈0.05）且该时点的组间有显著性差异（P〈0.01）。（4）两组的SpO2%与诱导前相比均无显著性差异（P〉0.05）。结论：七氟醚吸入诱导对血液动力学影响轻微,并具有心肌保护作用,使诱导更平稳,无痛简便,气味芳香,更易于小儿接受,是安全理想的麻醉方法。

Objective ：To investigate the application of sevoflumne inhalational induction and propofol intravenous induction in children heart surgery. Methods：Sixty children undertaking heart surgery were randomly divided into sevoflurane inhalational induction group （Sev group, n = 30） and propofol intravenous induction group （Pro group, n = 30）. The time to losing eyelash reflex and intubation were recorded. The incidence of cough , apnoea , and laryngospasm during the induction period were recorded too. The variety of MAP,HR,SpO2% were recorded in the every time point of induction. The data was analyzed with SPSS software. Results： （1）The mean time to losing eyelash reflex and intubafion in Pro group were significantly shorter than those in Sev group （P 〈 0. 01 ）. Coughing, apnoea , and laryngospasm weren＇t found during the induction period . （2） MAP of induction and intubation were significantly changed than those before induction. MAP of induction and intubation were significantly changed between the two groups（P 〈0. 05）. （3） The change of HR at intubation was significantly higher in Pro group than those in Sev group（P 〈0. 05）. （4） SPO2% had no significantly change between the two groups. Conclusion： Sevoflurane is most suitable to children heart surgery , induction was rapid and smooth, cardiovascular stability is good , easy to alter anaesthetic ＂depth＂. The children like its fruit smell. It is a safe and ideal anaesthesia technique.