异丙酚持续微泵输注在小儿术中维持与吸入七氟醚的比较

The comparison between continuous minipump infusion of propofol and inhalation of sevoflurane for maintaining anesthesia during the operations on children

目的对比七氟醚和异丙酚在小儿麻醉中的应用。方法择期手术患儿随机分为两组,七氟醚组入室后顿量吸入七氟醚意识消失后静推芬太尼1μg/kg和顺苯磺酸阿曲库铵0.1mg/kg,5～10s内注入,2min后插管或插入喉罩(根据手术方式选择)。术中以2%～3%的七氟醚维持麻醉,必要时追加芬太尼0.5μg/kg,手术结束前10～15min停七氟醚。异丙酚组入室后给予氯胺酮4～5mg/kg肌注,待意识消失后,开放上肢静脉通路,给予异丙酚3mg/kg静推,芬太尼1μg/kg和顺苯磺酸阿曲库铵0.1mg/kg,5～10s内注入,术中以异丙酚按3mg/(kg.h)微泵输注,必要时追加芬太尼0.5μg/kg。记录意识消失时间(s)、手术结束清醒(睁眼)时间;观察患儿诱导期是否合作、有无呛咳、喉痉挛、支气管痉挛等,恢复期有无躁动、恶心、呕吐等不良反应。结果七氟醚组清醒时间比异丙酚组明显缩短,两组均未发生屏气、喉痉挛、支气管痉挛等,苏醒后均无明显躁动。结论七氟醚适合小儿麻醉诱导。

Objective To compare the application of sevoflurane and propofol in pediatric anesthesia. Methods The patients undergoing elective surgery were randomly divided into two groups,sevoflurane group and propofol group.The patients of sevoflurane group inhaled sevoflurane after their entry into operation room. Intravenous injection of fentanyl 1 μg/kg and cisatracurium besylate 0.1 mg/kg were administrated within 5-10 seconds after their loss of awareness,followed by intubation or laryngeal mask aiiway（aceording to the way of operation）two minutes later. 2%-3% sevofiurane was used for maintaining anesthesia during the operation,with additional fentanyl given when necessary. The inhalation of sevoflurane was stopped 10- 15 minutes by the end of operation. The patients of propofol group were subjected to intramuscular injection of ketamine 4-5 mg/kg. The upper limber venous was cannulated when they lost their awareness,followed by intravenous injection of propofol 3 mg/kg,fentanyl 1μg/kg and cisatracurium besylate 0.1 mg/kg within 5-10 seconds. During the operation,the group were treated with propofol 3 mg/（kg·h） by minipump infusion,with additional fentanyl 0.5 μg/kg given when necessary. The length of time when the patients lost their awareness and the time when the patients regained their awareness （open their eyes） after operations was also recorded. The following situation was observed：if the patients cooperated with doctors and if they had irritating eough,laryngospasm or bronchospasm etc during the induction time;if they had adverse reaction such as restlessness,nausea and vomiting during convalescence. Results The recovery time of Group S was obviously shorter than that of Group Y（7.2 ± 2.6）min versus （14.7 ±3.4） min. Symptoms such as breath holding,laryngospasm and bronchospasm etc were not seen in the patients of the two groups. And after they regained their awareness,they didn＇t show obvious restlessness. Conclusion Propofol is suitable for the induction of pediatric anesthesia.