芬太尼用量对小儿扁桃体联合腺样体切除术后苏醒质量的影响

Effect of Different Fentanyl Dose to palinesthesia quality in children undergoing tonsillec- tomy and adenoidectomy

目的观察不同剂量芬太尼用于小儿插管全麻手术对术后苏醒质量的影响。方法选择60例ASA I-Ⅱ级择期行鼻内镜下扁桃体联合腺样体切除术患儿并随机分成3组。各组患者诱导用药均为：丙泊酚2.0mg／kg，维库溴铵0.1mg／kg，芬太尼2.5μg／kg，术中均以瑞芬太尼复合丙泊酚泵注维持。手术开始前，I组不追加芬太尼，Ⅱ组追加芬太尼2.0μg／kg，Ⅲ组追加芬太尼4.0μg／kg。观察指标：记录麻醉诱导前（T0）、气管插管后即刻（T1）、手术开始30分钟（T2）、手术结束时（T3）的心率（HR）、动脉收缩压（SBP）、动脉舒张压（DBP）、脉搏氧饱和度（SpO2）；记录各组患儿芬太尼、瑞芬太尼的用量和手术结束至呼吸恢复时间、至呼名睁眼时间、至拔出气管导管时间；记录各组患儿术后恶心呕吐、躁动及出手术室时自觉疼痛情况。结兽三组患儿各时间点的HR、SBP、DBP、SpO2与诱导前比较差异无显著性（P〉0.05）。麻醉持续时间三组比较无差异，麻醉药用量Ⅱ、Ⅲ组瑞芬太尼少于I组（P〈0.05）；呼吸恢复时间、呼名睁眼时间、拔出气管导管时间I组短于Ⅱ组，Ⅱ组短于Ⅲ组（P〈0.05）；苏醒后恶心呕吐发生率差异显著躁动率I组大于Ⅱ、Ⅲ组（P〈0.05）。三组均无术中知晓及其它麻醉并发症。结论小儿扁桃体联合腺样体切除手术开始前以芬太尼2.0μg／kg注入，术中以瑞芬太尼复合丙泊酚全凭静脉麻醉维持，可明显提高麻醉后苏醒质量。

Objective The aim of the study is to observe the effect of different fentanyl dose in children undergoing tonsillectomy and adenoidectomy. Methods Sixty patients with ASA I-Ⅱ,receiving selective tonsillectomy and adenoidectomy were randomly divided into three groups with 20 patients each. All groups anesthesia were maintained with propofol and remifentanil infusion. In group I 0μg/kg fentanyl was infused before operation,in group Ⅱ 2μg/kg fentanyl was infused before operation, in group Ⅲ 4μg/kg fentanyl was infused before operation. Parameters： HR of T0 T1 T2 T3, SBP, DBP, SpO2, and the time to spontaneous breathing（TSB）, time to extubation （TE） and time to eye opening（TEO）,were compared among the 3 groups. Results There were no significant difference in SBP, DBP, HR, SpO2 among three groups at T0-3（P〉0.05）. The dose of remifentanil in group I was significantly higher than those in group Ⅱ and group Ⅲ（P〈0.05）. The time to endotracheal extubation to eye opening and recovery of orientation in group I and Ⅱ were significantly shorter than in group Ⅲ（P〈0.05）. The incidence of emergence agitation in group I was obviously higher ：han group Ⅱ and group Ⅲ（P〈0.05）. Conclusion 2.0μa g/kg fentanyl was infused before tonsillectomy and adenoidectomy and maintenance of anesthesia by propofol and remifentanil infusion during operation can significantly improve the Palinesthesia Quality.