雷米芬太尼与芬太尼在小儿扁桃体摘除手术中的临床观察

Clinical application investigation of remifentanil and fentanyl in pediatric tonsillectomy

目的:探讨雷米芬太尼在小儿扁桃体摘除术中的有效性和安全性。方法:将30例患儿随机分为雷米芬太尼组(R组)和芬太尼组(F组)。R组给药:氯胺酮2mg·kg-1、丙泊酚lmg·kg-1、雷米芬太尼1μg·kg-1和罗库溴铵0.5μg·kg-1诱导插管,维持以输液泵泵入丙泊酚4～10mg·kg-1·h-1和雷米芬太尼0.25～0.5μg·kg-1·min-1;F组给药:氯胺酮2mg·kg-1、丙泊酚1mg·kg-1、芬太尼3μg·kg-1和罗库溴铵0.5mg·kg-1静脉推注诱导插管维持以输液泵泵入丙泊酚4～10mg·kg-1·h-1,间断静脉推入芬太尼1μg·kg-1·h-1。分别记录患儿麻醉前、插管前1min、插管后1min的SBP、DBP、HR;术毕停药后患儿自主呼吸恢复时间、呼唤睁眼时间、拔管时间;术后24h恶心、呕吐情况。结果:R组患儿术后呼吸恢复时间、呼唤睁眼时间、拔管时间与F组相比差异有统计学意义(P<0.05);麻醉诱导前两组血流动力学相似,插管前1minR组HR慢于F组(P<0.05);插管后1minR组SBP低于F组(P<0.05);术后恶心、呕吐的发生率及患儿年龄、性别、体重、手术时间等一般情况无统计学意义。结论:雷米芬太尼对血压、心率等血流动力学有良好的可控性,其麻醉镇痛效果好,诱导和苏醒迅速,术中平稳,不良反应小,值得临床推广。

Objective：To investigate the effects and safety of remifentanil and fentanyl in pediatric tonsillectomy.Methods：30 patients were randomly divided into remifentanil group（R） and fentanyl group（F）.R group administration：ketamine 2 mg/kg,propofol 1mg/ kg,remifentanil 1μg/kg and rocuronium 0.5 μg/kg induced by intubation,to maintain the infusion pump with propofol 4～10 mg/（kg·h） and remifentanil 0.25～0.5 μg/（kg·min）;F group administration：ketamine 2 mg/kg,propofol 1mg/kg,fentanyl 3 μg/kg and rocuronium 0.5 μg/kg,induced by intubation with intravenous injection,to maintain the infusion pump with propofol 4～10 mg/（kg·h）,intermittent intra-venous injection with funnepal 1 μg/（kg·h）.To record SBP,DBP,HR at preoperation,preoperative 1 min and postoperative 1 min,recovery time of spontaneous breathing after operation,calling for eye opening time,extubation time,and postoperative 24h vomiting and nausea.Results：The recovery time of spontaneous breathing after operation,calling for eye opening time and extubation time in R group had statistical difference compared with the F group（P〈0.05）.Hemodynamics before anesthesia was similar in the two groups.HR at 1min before extubation in R group was slower than that in F group（P〈0.05）,and SBP at 1min after extubation was lower than that in F group（P 0.05）.The occurrence of postoperative vomiting and nausea had no statistical significance.Conclusion：Remifentanil has better controllability to hemodynamics such as BP,HR,with better analgesic effect of anesthesia,rapid induction and awakening,smooth operation and few adverse reactions,which is worthy to be popularized.