眼科小儿不同全麻方式苏醒期躁动与清醒时间的比较

Comparison of different general anesthesia during recovery in ophthalmic operation of children

目的比较眼科手术患儿丙泊酚-瑞芬太尼静脉复合(PR)、丙泊酚-七氟醚静吸复合(PS)和七氟醚吸入(S)三种全麻方式苏醒期躁动及意识清醒的情况。方法选择90例ASAⅠ～Ⅱ级4～9岁患儿,其中视网膜玻璃体手术和额肌悬吊术各45例,随机等比分成PR组、PS组和S组(n=30)。观察拔管后1～40min七个时段三组患儿躁动(五级躁动评分≥4分者)的发生率及清醒时间。结果拔管后10、15、20、30min四个时段S组与PR组及PS组比较,躁动发生率显著增高(P<0.05),15min发生率最高(P<0.01),PR组与PS组比较,各时段差异均无统计学意义(P>0.05);PR组与PS组及S组比较,清醒时间显著减少(P<0.01),PS组与S组比较差异无统计学意义(P>0.05)。结论丙泊酚-瑞芬太尼麻醉苏醒期躁动发生率较低而且清醒时间短,苏醒质量优于其他两种麻醉。

Objective To compare the frequency of emergence agitation and the recovery time of anaesthesia with the group of propofol and remifentanil （PR）,the group of propofol and sevoflurane（PS）,and the group of sevoflurane（S） during recovery in patients undergoing ophthalmic operation of children.Methods Randomized trial enrolling 90 children aged 4～9 （ASA Ⅰ～Ⅱ） were prospected.Among them,45 children underwent retinal-vitrecous surgery and the other 45 children underwent frontalis muscle suspension surgery.They were randomly allocated to receive anaesthesia with three groups：combination propofol with remifentanil （PR）,combination propofol with sevoflurane（PS）,and sevoflurane（S） （n=30）.The incidence of emergence agitation and the time of recovery were observed in 1～40 minutes after extubation.Results The incidence of emergence agitation was significantly higher in S Group than that in PR Group and PS Group （P〈0.05） at the time of 10 min,15 min,20 min,30 min after extubation especially at the thim of 15 min（P〈0.01）.And there was no significant difference during PR Group and PS Group at different check-point （P〉0.05）.The time of recovery was significantly shorter in the PR Group than that in PS Group and S Group （P〈0.01） and there was no significantly difference in PS Group and S Group（P〉0.05）.Conclusions The incidence of emergence agitation was lowest and the time of recovery was shortest in the PR Group.The quality of recovery of anaesthesia with combination of propofol and remifentanil was better than that of sevoflurane,propofol-sevoflurane.