七氟醚-异丙酚静吸复合麻醉用于婴儿眼科手术的临床观察

Clinical Observation of Intravenous-inhaltion anesthesia using Sevoflurane Combined With Propofol in Infant Undergoing ophthalmic operation

目的探讨七氟醚-异丙酚静吸复合麻醉用于婴儿眼科手术的临床效果。方法择期行眼科手术患儿60例，性别不限，年龄3～12个月，随机分为两组，每组30例。I组患儿采用静吸复合麻醉，Ⅱ组患儿采用全凭静脉麻醉。I组患儿七氟醚4～6％吸入诱导，术中七氟醚吸入浓度调至1．5～2．5％，持续静脉注射异丙酚4mg/（kg·h）维持麻醉。Ⅱ组患儿肌肉注射氯胺酮6mg／kg，开放静脉，眯达唑仑0．1mg／kg、芬太尼2μg／kg、阿曲库铵0．5mg／kg诱导后气管插管，术中异丙酚4-6mg／（kg·h）持续静注维持麻醉。分别于麻醉诱导前（TO）、麻醉诱导后（T1）、气管插管时（T2）、停药时（T3）、气管拔管时（T4）、拔管后10min（T5），记录心率（HR）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PET-CO2）的变化，并记录苏醒时间、苏醒延迟发生率、呼吸再抑制发生率、苏醒期躁动发生率。结果与麻醉诱导前比较，I组T1时HR降低（P〈0．05）；与Ⅱ组比较，I组苏醒时间缩短，苏醒延迟发生率、呼吸再抑制发生率、术后躁动发生率均降低（P〈0．01）。结论七氟醚复合异丙酚用于眼科手术患儿麻醉可产生良好的麻醉效果，不良反应少，术后苏醒迅速，适合婴儿眼科手术。

Objective To observe the clinical effect of Intravenous-inhalation anesthesia using Sevoflu- rane combined with Propofol in infant undergoing ophthalmic operation. Methods 60 ASA I-Ⅱ children aged from 3 to 11 months were selected and randomly divided into two groups：intravenous combined with inhalation anesthesia group （ I group） （n =30） and total intravenous anesthesia group（Ⅱ group） （n =30）. Children in I group were induced with sevoflurane（4-6% ） and maintained with sevoflurane （ 1.5 - 2. 5% ） and propofol 4 mg/（ kg·h） during surgery, while those in II group were induced with midazolam 0. 1 mg/kg, fentanyl 2 μg/ kg, atracurium 0.5 mg/kg after ketamine 6 mg/kgintramuscular injection, and maintained with total intravenous anesthesia with propofol 4-6 mg/（ kg·h） The HR, SpO2 and PETCO2 were measured at different time points and recorded the post operation complications. Results Compared with T1 point, the HR was lower and the difference was significant in I group（P 〈 0. 05 ）. When compared with Ⅱ group the period of revival was shorter and the rates of post operation complications were much lower in I group （P 〈 0.01 ）. Conclusion The anesthe- sia method of Intravenous-inhalation combined with sevoflurane and propofol is an ideal method in infant under- going ophthalmic operation.