咪达唑仑复合瑞芬太尼丙泊酚在小儿斜视矫正术中麻醉效果观察

Clinical efficacy of midazolam combined remifential and popofol in pediatric patients undergoing stra- bismus surgery

目的:比较咪达唑仑复合瑞芬太尼丙泊酚麻醉与单纯瑞芬太尼丙泊酚麻醉在小儿斜视矫正术中的麻醉效果。方法:将70例择期行斜视矫正术患儿随机分为两组:Ⅰ组为咪达唑仑复合瑞芬太尼丙泊酚麻醉组,Ⅱ组为瑞芬太尼丙泊酚麻醉组,每组各35例。比较两组麻醉各时段血流动力学变化、瑞芬太尼丙泊酚使用剂量及苏醒情况,记录术中和术后不良反应的发生情况,记录麻醉诱导前、气管插管后、术中30min、术中60min及拔管后的收缩压、舒张压、心率、脉搏血氧饱和度及脑电双频指数。结果:两组在术中维持血压及心率较基础值均显著降低(均P<0.05);Ⅱ组在插管时血压与心率升高明显,与Ⅰ组相比差异显著(P<0.05)。Ⅱ组使用丙泊酚量较Ⅰ组显著增加(P<0.05),瑞芬太尼用量也有增加。Ⅰ组拔管期躁动的患儿比例与Ⅱ组相比显著降低(P<0.05)。两组拔管时间无显著性差异(P>0.05)。结论:瑞芬太尼丙泊酚麻醉用于小儿斜视矫正术中安全、有效,复合咪达唑仑后更为安全经济。

Objective：To compare the clinical efficacy and safety of midazolam/remifentail/propofol anesthesia with remifentail/propofol anesthesia in pediatric patients undergoing strabismus surgery.Methods：Seventy pediatric patients undergoing strabismus surgery were divided into midazolam/remifentail/propofol group （group Ⅰ ） and remifentail/propofol group （group Ⅱ ）randomly. Each group consisted of thirty-five cases.The intraoperative hemodynamic parameters and the dose of remifentail/propofol were compared.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,HR,SPO2 and BIS（bispectral index） were recorded before anesthesia induction,at the initiation after the intubation,30 min and 60 min during operation and after extubation.Adverse effect during and after the operation and conscious recovery time were recorded.Results：SBP,DBP and HR during tracheal intubation was significantly higher in group Ⅱ as compared with that （P〈0.05） in group Ⅰ,while during maintainence of operation were lower as compared with preoperative （P〈0.05）in two groups.The dose of propofol was significantly higher in group Ⅱ than that in group Ⅰ （P〈0.05）,and there was fewer children fid- geting in group Ⅰ than that in group Ⅱ （P〈0.05）.BIS value was maintained between 45 and 60 minutes.There was no significant difference about the time from stopping using remifentail and propofol to tracheal extubation.Conclusion：Remifentanil/propofol is an effective anesthesia in pediatric patients undergoing strabismus surgery,but combined midazolam will be more safe and cheap.