不同剂量瑞芬太尼和丙泊酚复合七氟醚麻醉用于表面麻醉下小儿气管异物取出术的临床研究

Topical anesthesia with different dose of remifentanil and propofol intravenous anesthesia combined with inhalational sevoflurane in children having foreign-body removed from bronchus

目的:探讨不同剂量瑞芬太尼和丙泊酚复合七氟醚麻醉用于表面麻醉下小儿气管异物取出术的临床效果及并发症发生情况。方法:60例行气管异物取出术的患儿,行舌根部、咽部及气管内依次表面麻醉后随机分为4组:氯胺酮对照组(K组)、丙泊酚+七氟醚组(PS组)、0.01μg.kg-1.min-1瑞芬太尼+丙泊酚+七氟醚(R1组)、0.03μg.kg-1.min-1瑞芬太尼+丙泊酚+七氟醚(R2组)。观察记录各组麻醉前、插入硬质支气管镜时、气管内硬质支气管镜探查取异物时、清醒时各时间点血压、心率、呼吸、脉搏血氧饱和度、并发症发生情况及苏醒时间。结果:K组在取异物过程中血流动力学变化大,易发生喉或支气管痉挛、呛咳及呼吸抑制等,苏醒时间长。与K组比较,PS组、R1组和R2组血流动力学相对平稳,喉或支气管痉挛、呛咳及呼吸抑制发生率低,苏醒时间短(P<0.05);与R1组比较,PS组和R2组患儿呼吸抑制的发生率较高(P<0.05)。结论:表面麻醉下小剂量瑞芬太尼和丙泊酚复合七氟醚应用于支气管异物取出术,术中麻醉深度易控制、安全平稳,术后苏醒迅速,并发症少。

Objective： To investigate the clinical effects and complications of different dose of remifentanil and propofol intravenous anesthesia combined with sevoflurane inhalational in operation of children＇s bronchial foreign-body removal.Methods：A randomized double-blind controlled trial was done with among 60 infant patients of American Society of Anesthesiologists Grade 2 or 3 status and aged 2 to 5 years old undergoing broncheal foreign-body removal,topical anesthesia was applied to the root of the tongue and pharyngeal portion and intra-trachea in turns beforehand and treated with one of the followings（n=15）：ketamine（group K）,propofol＋ sevoflurane（group PS）,0.01 μg·kg-1·min-1 remifentanil＋propofol＋ sevoflurane（group R1）,0.03 μg·kg-1·min-1 remifentanil＋propofol＋ sevoflurane（group R2）.The changes of blood pressure,heart rate,respiration,pulse O2 saturation were monitored at the time points of before anesthesia, inserting rigid bronchoscopy,rigid bronchoscopic tracheal foreign body exploratory and waking up, recovery time and complications were recorded at the same time. Results：The major hemodynamic changes,high incidence of throat or bronchial spasm,bucking and respiratory depression during the process of foreign body removal and the recovery time were obvious in group K.The relatively stable hemodynamics and the lower incidence of throat or bronchial spasm and cough and respiratory depression and a shorter recovery time were found in PS,R1 and R2 groups compared with that in K group（P〈0.05）;there was no obvious respiratory depression in R1 group,a higher incidence of respiratory depression in PS and R2 groups compared with that in R1 group（P〈0.05）.Conclusion：Small doses of remifentanil＋propofol＋sevoflurane inhalational combined intravenous anesthesia are satisfactory in the operation of bronchial foreign body removal from children, because it is easy to control the depth of anesthesia,thus it has the advantages of safety and stability and rapid recovery and few complications.