瑞芬太尼复合丙泊酚静脉全麻与异氟醚吸入全麻在小儿眼科手术中比较

Application of remifentanil combined propofol intravenous anesthesia in pediatric ophthalmic surgery

目的:比较瑞芬太尼复合丙泊酚静脉全麻用于小儿眼科手术麻醉的安全性、有效性及可控性。方法:选择择期眼科手术的小儿40例,随机分为两组:瑞芬太尼复合丙泊酚静脉全麻组(RP组)和异氟醚吸入全麻组(I组),每组20例。麻醉诱导采用咪唑安定0.05mg·kg-1,丙泊酚2mg·kg-1,维库溴胺0.1mg·kg-1,观察组用瑞芬太尼2μg·kg-1,对照组用芬太尼3μg·kg-1,气管插管后机械通气,RP组麻醉维持采用静脉持续输注瑞芬太尼0.1μg·kg-1.min-1和丙泊酚,I组麻醉维持用异氟醚吸入,术中根据麻醉深度调整异氟醚吸入浓度和丙泊酚输注速度。观察围术期两组血流动力学变化、自主呼吸恢复、气管拔管和清醒的时间,苏醒后躁动和恶心呕吐的发生率。结果:两组病人平均动脉压(MAP)变化:两组T1、T2、T3、T4与T0比较,MAP明显降低(P<0.05),T5与T0比较,MAP无明显差异(P>0.05);组间比较,两组在T0、T1、T2、T3、T4、T5点,MAP无明显差异(P>0.05)。两组病人心率(HR)变化:I组:T3、T4、T5与T0比较,心率显著增快(P<0.05),RP组:T1、T2、T3、T4与T0比较,心率明显降低(P<0.05),T5与T0比较,心率变化无明显差异(P>0.05)。组间比较,两组在T0心率无明显差异,T1、T2、T3、T4、T5观察组与对照组比较,心率明显降低(P<0.01)。麻醉苏醒时间比较:RP组与I组比较,病人自主呼吸恢复时间、意识恢复时间和拔管时间均明显缩短(P<0.05)。RP组术后躁动、恶心呕吐发生率,均低于I组(P<0.05)。结论:瑞芬太尼复合丙泊酚静脉全麻可为小儿眼科手术提供稳定血流动力学状态,快速苏醒,适用于小儿眼科手术麻醉。

Objective： To compare the safety, efficacy and controllability of intravenous anesthesia using Remifentanil and Propofol in pediatric ophthalmic surgery. Methods： 40 children undergoing ophthalmic were randomly divided into Remifentanil with Propofol group （n=20） and Isoflurane group（n=20）. Anesthetic induction： In Isoflurane group： Midazolam 0.05mg.kg^-1 iv, Fentanil 3μg·kg^-1 iv, Propofol 2 mg.kg^-1, anesthesia was maintained by Isoflurane; In Remifentanil with Propofol group： Midazolam 0.05mg-kg-1 iv, Remifentanil 2μg·kg^-1 and Propofol 2mg.kg^-1 iv, anesthesia was maintained by Remifentanil 0.11μg·kg^-1·min^-1 and Propofol were continuously pumped intravenously, Perioperation hemodynamics, time of breath recovery and extubation and awake, restlessness and nausea were recorded. Results： MAP： The was a significant decrease in two groups at T1,T2,T3,T4 compared with T0 （P〈0.05）. Compared with T0,there was no significant difference at T5 in two groups （P〉0.05）. There was no significant difference at T0,T1,T2,T3,T4,T5 between group Remifentanil with Propofol and group Isoflurane. （P〉0.05）. HR： Compared with To, there was a significant increase at T1, T2,T3,T4,T5 in group Isoflurane （P〈0.05）. In the group Remifentanil with Propofol, there was a significant desease at T1,T2,T3,T4 compared T0 （P〈0.05）. There was no difference at T5 compared with To in group Remifentanil with Propofol. Between group Isoflurane and group Remifentanil with Propofol, HR had no significant difference at To. Compared with group Isoflurane,there was a significant decrease at T1,T2,T3,T4,T5 （P〈0.01）. Anaesthesia analepsia time： Compared with group Isoflurane,there was a significant decrease of the consciousness awareness and spontaneously breathing recoverytime and extubate time in group Remifentanil with Propofol （P〈0.05）. there was a significant decrease of nausea and vomiting and the body movement and restless in group Remifentanil with Propofol （P〈0.05）. Conclusion： Remifentanil combined with Propofol could provide anesthesia of stable hemodynamic, fast recurrence suitable for ophthalmic surgery in pediatric patients.