七氟醚与丙泊酚复合瑞芬太尼麻醉用于眼科手术喉罩气道患儿的比较

A comparison of sevoflurane versus propofol-remifentanil for children with laryngeal mask insertion undergoing ophthalmic surgery

目的比较眼科手术患儿七氟醚与丙泊酚复合瑞芬太尼麻醉术中血流动力学及麻醉恢复情况。方法择期行眼科手术(斜视矫正术、白内障摘除术、眶内肿物摘除术)患儿40例,ASAⅠ级或Ⅱ级,随机分为七氟醚组(S组)与丙泊酚复合瑞芬太尼组(PR组),每组20例。麻醉诱导相同,咪达唑仑0.05 mg/kg,芬太尼3μg/kg,丙泊酚2 mg/kg,插入喉罩。麻醉维持:S组吸入七氟醚,氧流量2.0 L/min,呼气末浓度1.0 MAC,手术结束时,停止吸入七氟醚,纯氧吸入,氧流量调整为5.0 L/min。PR组瑞芬太尼0.10μg/(kg.min)恒速输注,丙泊酚在静注2 mg/kg后6 min以9 mg/(kg.min)恒速输注,40 min后7 mg/(kg.min)恒速输注,两组术中均未使用肌松药。记录两组患儿术中收缩压(SBP)、舒张压(DBP)、心率(HR)、听觉诱发电位指数(AEPI)。记录手术时间、术毕自主呼吸恢复时间,拔除喉罩时间,Aldrete评分达到9分时间及麻醉恢复室(PACU)停留时间。结果与PR组比较,S组自主呼吸恢复时间缩短(P<0.05),但拔除喉罩时间两组差异无统计学意义,Aldrete评分达到9分时间及PACU停留时间延长(P<0.05)。与诱导前比较,两组在插入喉罩即刻、手术开始后5 min、10 min、15 min、30 min SBP、DBP均降低(P<0.05),但两组间比较差异无统计学意义;PR组HR降低(P<0.05),两组间比较差异有统计学意义(P<0.05)。结论眼科手术喉罩气道患儿七氟醚麻醉或丙泊酚复合瑞芬太尼麻醉循环稳定;七氟醚麻醉患儿呼吸恢复较快,丙泊酚复合瑞芬太尼麻醉患儿早期意识状态恢复较好。

Objective To compare the efficacy between sevoflurane versus propofol-remifentanil for children with laryngeal mask insertion undergoing ophthalmic surgery.Emphasis was put on hemodynamic reaction and recovery profile.Methods Forty ASA Ⅰor Ⅱchildren,undergoing ophthalmic surgery in which the use of laryngeal mask（LMA） were randomly divided into 2 groups（n=20 each）：group Ⅰ sevoflurane（S） and group Ⅱ propofol-remifentanil（PR）.Anesthesia was induced with midazolam 0.05 mg/kg,fentanil 3 μg/kg,propofol 2 mg/kg in both groups,then LMA was inserted.In group S,anes-thesia was maintained with sevoflurane which kept at 1.0 MAC.At the end of the surgery,sevoflurane inhalation was stopped and fresh gas flow rate was reached 5 L/min.In group PR,remifentanil was infused at 0.10 μg/（kg.min） at 6 minutes after induction;propofol was infused at 9 mg/（kg.min） 40minutes later was infused at 7 mg/（kg.min）.Muscle relaxant was not used in both groups.The following variables were recorded during the operation： SBP,DBP,HR,and AEPI.The time from the discontinuation of anesthetic to breath recovery,removal of LMA,Aldrete score of 9 were recorded.Results Spontaneous ventilation time was shorter in group S than that in group PR（P〈0.05）,but the time to removal of LMA was not different in both groups.The time from the discontinuation of anesthetic to Aldrete score of 9 and discharge from PACU were shorter in group PR than those in group S（P 〈0.05）.Compared to baseline,SBP and DBP were lower at LMA was inserted,5,10,15 and 30 min.HR was lower in group PR than that in group S（P〈0.05）.Conclusion Sevoflurane or propofol-remifentanil may have stable hemodynamics for children with laryngeal mask insertion undergoing ophthalmic surgery.Spontaneous breathing recovery time is shorter in sevoflurane group and the early recovery quality is higher in propofol-remifentanyl group.