不同浓度七氟醚对小儿全麻苏醒期躁动发生率的影响

Effects of different concentrations of sevoflurane on the agitation incidence in pediatric anesthesia

目的探讨不同浓度的七氟醚对小儿全麻苏醒期躁动发生率的影响。方法选择择期在全麻下行小儿骨科、会阴或下腹部手术患儿88例,随机分成A、B两组,每组各44例。所有患儿术前均不给药。采用面罩吸入浓度为1%～7%七氟醚+1.5%氧气作全麻诱导,至睫毛反应消失。开放静脉通道后即泵入瑞芬太尼。A、B两组患者呼气末的七氟醚浓度分别维持在0.5最低肺泡有效浓度(MAC)、1MAC,监测各项生命体征,维持患儿辅助呼吸及呼气末CO2(ETCO2)。观察两组患者麻醉平稳、呼吸抑制的程度、血流动力学的稳定性、药物用量和苏醒情况。结果两组患者术中麻醉效果佳,血流动力学稳定。A组患者苏醒期躁动发生率为11.3%(5/44),显著低于B组的36.4%(16/44),两者比较差异有统计学意义(P<0.05)。两组间的睁眼时间及离室时间的比较差异均有统计学意义(P<0.05),两组患者七氟醚及瑞芬太尼用量比较差异有统计学意义(P<0.01),而两组的体动反应、呼吸抑制发生例数及手术时间比较差异无统计学意义(P>0.05)。结论低浓度七氟醚联合瑞芬太尼应用于小儿吸入复合麻醉的麻醉效果平稳,苏醒快,安全性高,躁动发生率较高浓度七氟醚低,且可减少药物用量。

Objective To investigate the influence of different concentrations of sevoflurane on the agitation incidence in pediatric anesthesia.Methods 88 cases of children who need pediatric anesthesia surgeries including orthopedic surgeries,surgeries on perineum and the lower abdomen were randomly divided into two groups（group A and group B）,44 cases in each group.All patients have not received drug before surgery.Anesthrsia was induced by 1% to 7% sevoflurane and 1.5% oxygen through mask till eyelash loss of response,and pump in remifentanil through venous channel.The concentration of sevoflurane in group A was maintained at 0.5 minimum alveolar concentration of each agent througkout surgery while 1 minimum alveolar concentration in group B.Vital signs were observed and assisted breathing as well as end-tidal CO 2（ETCO 2） were maintained.Anesthesia stability,the degree of respiratory depression,hemodynamic stability,drug dosage and the situation among awake were recorded.Results The effects of both groups were satisfying and hemodynamic condition was stable.Agitation incidence was 11.3%（5/44）in group A,which was significantly lower than 36.4% of group B.Both time of eyesopening and time of leaving the operating room of the two groups were significantly different（P0.05）,so as the dosages of sevoflurane and remifentanil（P 0.01）.But cases of movement in response and respiratory depression were of no significant difference（P0.05） between group A and B.Conclusion The effect of the low concentration of sevoflurane combined with remifentanil in pediatric anesthesia was better than the high concentration because it provided quicker emergence,safety and lower agitation incidence.