咪唑安定复合瑞芬太尼丙泊酚用于小儿先天性肛门闭锁手术麻醉的临床观察

Clinical Investigation of Midazolam Combined Remifentanil and Propofol in Pediatric Patients Undergoing Operation for Congenital Anal Atresia

目的观察咪唑安定复合瑞芬太尼丙泊酚麻醉是否较单纯瑞芬太尼丙泊酚麻醉在手术治疗小儿先天性肛门闭锁中使用更为安全合理。方法32例择期手术治疗小儿先天性肛门闭锁,随机分为两组:咪唑安定复合瑞芬太尼丙泊酚麻醉组(A组)和瑞芬太尼丙泊酚麻醉组(B组),每组16例。比较两组麻醉各时段血流动力学变化、瑞芬太尼丙泊酚使用剂量及苏醒情况。结果两组在术中维持及拔管前血压、心率较基础值均降低(P<0.05);B组在插管时血压升高明显,与A组相比统计学上有意义(P<0.05)。B组使用丙泊酚量较A组显著增加(P<0.05),瑞芬太尼用量也有增加趋势,但差异无统计学意义(P>0.05)。A组拔管期躁动的患儿比例也较低。两组拔管时间差异统计学上无意义(P>0.05)。结论咪唑安定复合瑞芬太尼丙泊酚麻醉是一种有效的手术治疗小儿先天性肛门闭锁的麻醉方法。

Objective To compare the clinical efficacy and safety of midazolam,remifentanil and propofol anesthesia with remifentanil and propofol anesthesia in pediatric patients undergoing operation for congenital anal atresia. Methods Thirty-two pediatric patients undergoing operation for congenital anal atresia were randomized into midazolam and remifentail and propofol group（group A） and remifentail and propofol group（group B）. Each group consisted of 16 cases. The intraoperative hemodynamic parameters,the dose of remifentail/propofol and recovery profile were compared. Results MAP during tracheal intubation was significantly higher as compared with preoperative（P〈 0.05）in group B, while during maintainence of operative and before tracheal extubation were lower as compared with preoperative（P 〈 0.05 ） in two groups. HR was significantly lower at maintainence of operative and before tracheal extubation in two groups. The dose of propofol was significantly higher in group B than that in group A（P 〈 0.05）,and there was fewer children fidgesting in group A than that in group B. There was no significant difference about the time from stopping using remifentail and propofol to tracheal extubation. Conclusion Midazolam combined remifentanil and Propofol is an effective anesthesia in pediatric patients undergoing operation for congenital anal atresia.