喉罩—雷米芬太尼复合丙泊酚在小儿微创手术中的应用

Application of Laryngeal Mask-remifentanil Joint Propofol in Polio-minimally Invasive Surgery

目的比较喉罩-雷米芬太尼联合丙泊酚与喉罩-氯胺酮联合咪达唑仑两种麻醉方法在小儿腹腔镜疝囊高位结扎术中应用的优缺点。方法64例择期行腹腔镜疝囊高位结扎术患儿。随机均分为喉罩-雷米芬太尼联合丙泊酚组（雷米芬太尼组）与喉罩-氯胺酮联合咪迭唑仑组（氯胺酮组）。静脉快速诱导置入喉罩后，雷米芬太尼组静脉泵入雷米芬太尼0．15ug／kg·min及丙泊酚6—8mg／kg·h维持麻醉，氯胺酮组患者静脉泵入氯胺酮0．08—0．1mg／kg·min及咪达唑仑0．15～0．2mg／kg·h维持麻醉。记录患者术中生命体征、苏醒时间、术中及术后并发症发生情况。结果麻醉诱导后雷米芬太尼组平均动脉压（MAP）及心率（HR）明显低于麻醉前水平（P〈0．05），而氯胺酮组不明显，腹腔充气后，两组MAP及HR比充气前上升明显（P〈0．05）而氯胺酮组上升更明显。雷米芬太尼组苏醒时间明显短于氯胺酮组（P〈0．05），且氯胺酮组术中肢动、呛咳屏气及术后躁动明显多于雷米芬太尼组（P〈0．05）。结论喉罩-雷米芬太尼联合丙泊酚用于小儿腹腔镜微创手术具有诱导苏醒迅速、血流动力学相对平稳，且不良反应少等优点。

Objective To compare two anesthesia methods＇ advantages and disadvantages, comparative laryngeal mask - remifentanil joint propofol with laryngeal mask - ketamine joint midazolam in podiatric laparoscopic high ligation of hernia sac. Methods 64 cases of selective patients in pediatric laparoscopic high ligation of hernia sac were randomly divided into two groups, group of laryngeal mask - remifentanil joint propofol （ group remifentanil ） and group of laryngeal mask - ketamine joint midazolam （group ketamine ）. After rapid intravenous anesthetic induction inserting laryngeal mask, remifentanil 0.15 ug/（ kg . min ） and propofol 6 - 8 mg/kg. 2 mg/ （ kg . h ） were pumped into the vein of group remifentanil to maintain anesthesia. Vital signs, recovery time, operative and postoperative complications were recorded. Ketamine 0.08 - 0. 1 mg/（ kg. min） and midazolam 0. 15 -0. 2 mg/（ kg . h ） were pumped into the vein of group ketamine. Result After Intravenous anesthetic induction MAP and HR of group remifentanil clearly lowered compared with that before anesthesia （ P 〈 0.05 ） and group ketamine was not obvious. After celiac inflated, MAP and HR of two groups was higher than before inflatable （P 〈 0.05 ） and group ketamine was more obvious. Recovery time of group remifentanil was clearly shorter than group ketamine （ P 〈 0.05 ）. Incidence of intraoporative limbs, cough, holding breath and postoperative restlessness in group ketamine was clearly higher than group remifentanil （ P 〈 0.05 ）. Conclusion Advantages of laryngeal mask - remifentanil joint propofol in laparoscopic polio - minimally invasive surgery were rapid induction of anesthesia and recovery,relatively stable hemodynamics,fewer adverse reactions and etc.