瑞芬太尼和氯胺酮用于小儿支气管异物探取术的临床比较

Comparison between remifentanil and ketamine combined with propofol intravenous balanced anesthesia for tracheobronchial foreign body removal in children

目的对比研究瑞芬太尼复合丙泊酚或氯胺酮静脉麻醉用于小儿气管异物探取术的效果。方法 24例气管异物患儿,分为瑞芬太尼组(R组)和氯胺酮组(K组),每组各12例。对比观察麻醉手术过程中患儿缺氧发生率(SpO2<95%和85%的次数),咽喉分泌物分级、手术及麻醉苏醒时间、苏醒评分情况。结果 R组的术中缺氧发生率明显低于K组,且咽喉部分泌物分级明显降低(P<0.01);R组的手术时间(P<0.05)及术后苏醒时间(P<0.01)也短于K组,苏醒评分具有显著优势(P<0.01)。结论与传统的氯胺酮麻醉比较,瑞芬太尼复合丙泊酚静脉麻醉用于小儿支气管异物探取术,其麻醉效应更平稳,术中及术后不良反应更轻,苏醒更快且苏醒质量更高。

[ Objective ] To compare the effects of remifentanil or ketamine intravenous anesthesia combined with propofol during tracheobronchial foreign body removal in children. [Methods ] Twenty-four children scheduled for tracheobronchial foreign body removal were randomly divided into two groups： Remifentanil group （R, n =12） and ketamine group （K, n =12）. Intravenous anesthesia was performed in all patients. Pulse oxygen saturation （SpO2）, the grades of throat secretions, the durations of operation, the awaking time from anesthesia and the palinesthesia scores were recorded. [Results] Compared with group K, the incidence rate of intraoperative anoxia （the frequency of SpO2 lower than 95% or 85%） and the grades of throat secretions were significant lower in group R （P 〈0.01）, the durations of operation and the awaking time from anesthesia of group R were also shorter than that of group K （P 〈0.05, P 〈0.01, respectively）, the palinesthesia scores of group R were more superior than group K （P 〈0.01）. [ Conclusions] Compared with traditional intravenous anesthesia of ketamine, the effects of intravenous anesthesia of remifentanil combined with propofol were more effectively on bronchial foreign body removal in children, the adverse reactions during and after surgery was smaller, the children waked up faster and the quality of palinesthesia was better in group R.