舒芬太尼与瑞芬太尼在小儿扁桃体、腺样体切除手术中麻醉的比较

Comparison of sufentanil and remifentanil in the anesthesia of pediatric tonsillectomy and adenoidectomy surgery

目的:观察舒芬太尼与瑞芬太尼在小儿扁桃体、腺样体切除手术中及术后的镇痛和镇静作用。方法:选择择期进行扁桃体、腺样体切除手术的患儿100例,随机分为舒芬太尼组(S组)50例和瑞芬太尼组(R组)50例。S组以舒芬太尼0.2μg/kg快速诱导,以0.2μg.kg-1.h-1术中维持,手术结束前30 min停药。R组以瑞芬太尼2μg/kg快速诱导,以6μg.kg-1.h-1术中维持,手术结束前5 min停药。分别观察2组术中、术后血流动力学指标及术后患儿镇痛和镇静程度。结果:2组术中血流动力学指标差异无统计学意义(P>0.05)。拔管后5 min时S组平均动脉压与基础值差异无统计学意义;R组HR较S组明显增高(P<0.01)。S组患儿术后Ramsay评分较适宜,VAS评分较低。结论:两种药物均能较好地用于小儿扁桃体、腺样体切除手术,舒芬太尼在提高术后麻醉恢复质量上和安全性上更有优势。

Objective：To observe the analgesic and sedative effects of sufentanil and remifentanil during and after pediatric tonsillectomy and adenoidectomy surgery.Methods：One hundred patients involved in selective operation were chosen and divided into two groups randomly：sufentanil group（S group,n=50） and remifentanil group（R group,n=50）.Patients in S group were rapidly induced by 0.2 μg/kg sufentanil,and were maintained with 0.2 μg·kg-1·h-1 in the operation.Sufentanil was withdrawn 30 min before the operation completed.Patients in R group were rapidly induced by 2 μg/kg remifentanil,and were maintained with 6 μg·kg-1·h-1 in the operation.Remifentanil was withdrawn 5 min before the operation completed.The hemodynamic indexes during and after the operation as well as the postoperative sedative degree of patients in the two groups were respectively observed.Results：No significant difference of hemodynamic indexes during the operation was observed between the two groups（P0.05）.No obvious difference was shown between the mean arterial pressure 5 min after removing tube in S group and the basic values;and a statistical difference was shown in R group（P0.01）.The Ramsay score of children in S group after operation was more appropriate,and VAS score was lower.Conclusions：Both sufentanil and remifentanil drugs can be good applied in pediatric tonsillectomy surgery.Sufentanil shows more advantages in improving the recovery quality and security of anesthesia after surgery.