瑞芬太尼复合丙泊酚靶控输注在小儿脑瘫手术中的应用

Remifentanil and propofol with total intravenous anesthesia for pediatric cerebral palsy

目的评价瑞芬太尼复合丙泊酚全凭(TCT)静脉麻醉用于小儿脑瘫的临床效果。方法选择择期需全麻下行肌力肌张力调整术或者行颈动脉剥脱术手术的患儿50例,随机分成A组和B组各25例。A组麻醉诱导(咪达唑仑0.2mg/kg、丙泊酚1.0mg/kg、瑞芬太尼1.5μg/kg、琥珀胆碱2mg/kg)。麻醉维持连续靶控输注丙泊酚2～4mg/(kg·h)微量持续泵注瑞芬太尼0.1～0.25μg/(kg·min)能用肌松剂的维库溴胺0.03μg/(kg·min)B组麻醉实施中麻醉诱导中瑞芬太尼改用芬太尼0.5～1μg/kg麻醉维持中微量泵持续泵入瑞芬太尼改为间断推注芬太尼0.1μg/(kg·min)其余药物使用方法及剂量同A组。结果丙泊酚联合瑞芬太尼比丙泊酚联合芬太尼更能有效的控制麻醉诱导和手术过程中血压和心率的上升并且使用瑞芬太尼组的患儿苏醒时间及拔管时间较使用芬太尼组明显缩短,术中丙泊酚的用量也大大减少。结论丙泊酚联合瑞芬太尼适用于脑瘫患儿手术,且效果优于丙泊酚联合芬太尼。

Objective evaluation of propofol combined with remifentanil （TCT） with total intravenous anesthesia for pediatric cerebral palsy. Methods Selective required general anesthesia with muscle force and tension adjustment or carotid endaxterectomy operation in 50 cases, were randomly divided into A group and B group with 25 cases in each group. Induction of anesthesia （ group A midazolam propofol 0. 2 mg/kg, 1.0 mg/ kg, 1.5 μg/kg, remifentanil suecinylcholine 2 mg/kg）. Anesthetic maintenance of continuous propofol target controlled infusion [ 2 - 4 mg/（ kg·h） ] of continuous pump infusion of remifentanil 0. 1 - 0. 25 μg/（ kg·min） can use the muscle relaxant vecuronium 0.03 μg/（ kg·min）B group of anesthesia during induction of an- esthesia with remifentanil and fentanyl in using 0.5 -1 μg/kg anesthesia was maintained in trace pump continu- ously pumps the remifentanil to intermittent bolus injection of fentanyl 0. 1 μg/（ kg ·min） remaining drugs us- age and dosage with the A group. Results The of propofol combined with fentanyl than propofol in combination with fentanyl can effectively control the induction of anesthesia and operation process of the blood pressure and heart rate increased and the use of remffentanil group in recovery time and extubation time than the use of fenta- nyl group was significantly shorter, intraoperative dosage of propofol significantly reduced. Conclusion Propo- fol combined with remifentanil applied to children with cerebral palsy operation, and the effect is better than that of propofol in combination with fentanyl effect.