七氟烷瑞芬太尼静吸复合麻醉在小儿斜视手术中的应用

Sevoflurane-remifentanil-based anaesthesia in children undergoing strabismus surgery

目的观察七氟烷瑞芬太尼静吸复合麻醉在小儿斜视手术中麻醉维持、苏醒及术中、术后并发症的发生。方法拟行斜视矫正术的ASAⅠ级住院患儿60例,随机分为实验组和对照组,每组30例,两组均采用异丙酚、瑞芬太尼、咪唑安定、阿曲库铵诱导气管插管。实验组(SR组)采用七氟烷瑞芬太尼静吸复合麻醉方式维持麻醉;对照组(PR组)采用异丙酚瑞芬太尼全凭静脉麻醉方式维持麻醉。观察两组患儿的血流动力学变化特征;记录术毕停药后患儿自主呼吸恢复满意时间、拔管时间、意识恢复时间;观察术中及术后麻醉并发症出现情况。结果①术中SR组患儿血流动力学相对平稳,PR组患儿血流动力学变化较大,两组血流动力学变化差异有统计学意义(P<0.05)。②SR组停药后患儿自主呼吸恢复满意时间、拔管时间、意识恢复时间均较PR组时间略短,但组间差异无统计学意义(P>0.05)。③术中眼心反射发生SR组6例(20%)PR组16例(53%),组间差异有统计学意义(P<0.01);术后躁动SR组9例(30%)PR组2例(7%),组间差异有统计学意义(P<0.01);术后恶心、呕吐SR组2例(7%)PR组3例(10%),组间差异无统计学意义。结论七氟烷瑞芬太尼静吸复合麻醉能安全、有效用于小儿斜视手术,较异丙本酚瑞芬全静脉麻醉优点是:血流动力学更平稳、术中眼心反射发生率更低,但是术后躁动发生比例更高。

Objective To evaluate the efficacy and satety of sevoflurane inhalation supplemented with remifentanil infu- sion in children undergoing strabismus surgery. Methods Sixty hospitalized children aged 2 -12 years were induced with midazulon, attrcurium, propofol, remifentanil. Then they were randomly allocated to 2 groups, in group SR （ n = 30 ）, the anesthesia was maintained with sevofurane inhalation supplemented with remitentanil infusion;in the group PR（ n = 30）was maintained with eontinuous intravenous infusion of propofol and remifentanil. The hemodynamie characteristic was recorded and observed. The resumed spontaneous ventilation time, extubation time,consciousness recovery time,inoperative and postoperative complication were evaluated. Results The hemodynamic characteristic of SR group was more stable than PR group in operation procedure （P〈 0.05 ）. No significant difference was observed in resumed spontaneous ventilation time, extubation time, consciousness recovery time, nausea and vomiting（ P〉0. 05 ）. The incidence of oculoeardiae reflex（OCR） in group SR was lower than that in group PR. But the occurrence of emergence agilation was more in SR than that in PR（ P〈0. 01 ）. Conclusion Sevoflurane-remifentanil- based anaesthesia provides better stablilization,lower OCR incidence than propofol-remifentanil-based anaesthesia in children undergoing strabismus surgery.