雷米芬太尼在小儿扁桃体和腺样体切除术麻醉中的应用

The application of remifentanil in anasthesia in children's tonsilletomy and adenoidectomy

目的探讨雷米芬太尼用于小儿扁桃体和腺样体切除术全麻的安全性及效果。方法60例阻塞性睡眠性呼吸暂停综合征患儿（3～8岁），择期行扁桃体和腺样体切除术，随机平均分为3组各20例：雷米芬太尼与丙泊酚组（R组），芬太尼与丙泊酚组（F组），氯胺酮与丙泊酚组（K组）。记录麻醉诱导前（Tn）、气管插管即刻（T1）、手术开始30min（T2）、手术结束时（T3）、拔管后5min（T4）的心率（HR）、上肢收缩压（SBP）、舒张压（DBP）、脉搏氧饱和度（SpO2）；各组患儿术毕停药到自主呼吸恢复时间以及拔管时间。结果各组间患儿的性别比、年龄、体重、麻醉时间等差异无统计学意义。血流动力学参数R组、F组T1时点组内比较有下降，差异有统计学意义（P〈0．05）；与K组比较，R组、F组T1时点下降有统计学意义（P〈0．05）；自主呼吸恢复时间、拔管时间以R组最短，F组次之，K组最长（P〈0．05，或P〈0．01）。结论雷米芬太尼复合丙泊酚静脉麻醉用于儿童扁桃体和腺样体切除术安全、有效，诱导和苏醒迅速，术中平稳。

Objective To assess the effects and security of Remifentanil in anaesthesia in children＇ s tonsillectomy and Adenoidectomy. Methods Sixty children aged 3 - 8 undergoing elective operation for obstructive sleep apnea hypohea syndrome, were randomized to one of three groups to reseeive the following： remifentanil combined with propofol group （ goup R ）, fentanyl combined with propofol group（ group F）, ketamine combined with propofol group（group K）. After the implementation of the induction of anesthesia endotracheal intubation, parallel mechanical ventilation. Records before the induction of anesthesia（T0 ）, endotracheal intubation instantly（T1 ）, started operation after 30 min （T2 ）, the end of operation （ T3 ）, extubation after 5 min （ T4 ） of heart rate （ HR ）, upper limb systolic blood pressure（SBP）, Diastolic blood pressure（DBP）, the pulse of oxygen saturation（SpO2 ）. Each group of children with complete withdrawal to resume breating independently and extubation time. Results Among all groups of children with sex ratio, age, weight, anesthesia time difference was not significant. Compared with the K Group, the modynamics of group R and F at T1 fell more, had a significant difference P 〈 0.05 ） ; shortest Breathing independently recovery time, time to extubation group R, F Group followed, K longest group （ P 〈 0.05, orP 〈 0.01 ）. Conclbsion Remifentanil combined with propofol intravenous anesthes8ia for children＇ s tonsils and adenoids removed for safe, effective, rapid induction and regained consciousness.