瑞芬太尼复合丙泊酚联合高频喷射通气在小儿呼吸道异物取出术中的临床观察

Remifentanil,Propofol and High Frequency Jet Ventilation Used for Respiratory Tract Foreign Body Removal in Children.

目的研究瑞芬太尼复合丙泊酚联合高频喷射通气用于小儿呼吸道异物取出术的临床效果。方法 52例行气管异物取出术患儿,随机分为瑞芬太尼复合丙泊酚联合高频喷射通气组(A组)和氯胺酮复合γ-羟基丁酸钠组(B组)各26例,比较手术时间、苏醒时间、及术中各时点生命体征变化,并比较术中、术后并发症发生率。结果两组患儿手术时间无显著性差异,但B组苏醒时间显著长于A组(P<0.05)。A组患儿在置入支气管镜和钳取异物两时点的平均动脉压及心率均显著低于B组(P<0.05),而脉搏氧饱和度显著高于B组(P<0.05)。A组患儿术中、术后并发症发生例数显著少于B组患儿(P<0.05)。结论小儿呼吸道异物取出术采用瑞芬太尼复合丙泊酚联合高频喷射通气能维持呼吸循环稳定、麻醉平稳,利于手术操作,是一种切实可行的麻醉方法。

Objective To investigate the clinical effect of combined use of remifentanil, propofo! and high frequency jet ventilation for respiratory tract foreign body removal in children. Methods Fifty - two children undergoing respiratory tract foreign body removal operations were randomly divided into two groups： group A with remifentanil, propofol and high frequency jet ventilation （n = 26）, and group B with ketamine and sodium γ-hydroxybutrate（ n = 26 ）. The changes of operation time, awaken time, vital signs and the incidence of intra/post- operative complications were observed. Results There was no significant differences in operation time, but awaken time in group A was significantly longer than that in group B（P 〈0.05）. MAP and HR at the time point of bronchial endoscopy and foreign body removal in group A were markedly lower than those in group B （ P 〈 0.05）, and SpO2 was markedly higher in group A as compared with group B（P 〈0.05）. The incidence of complications in group A was significantly lower than that in group B（P 〈0.05）. Conclusion Combined use of remifentanil, propofol and high frequency jet vetilation is a safe and practicable method for respiratory tract foreign body removal in children.