七氟烷与瑞芬太尼复合丙泊酚在小儿唇腭裂修补术中的麻醉效果

Clinical comparison of sevoflurane and propofol anesthesia with propofol and remifentanil anesthesia for children with cleft lip and palate repair surgery

目的比较七氟烷与瑞芬太尼复合丙泊酚用于小儿唇腭裂修补术麻醉的效果和安全性。方法选择杭州口腔医院和浙江大学医学院附属儿童医院2011年4月至2012年12月择期行唇腭裂修补术的患儿60例，经医院伦理委员会批准，数字随机法分为2组，每组30例，S组采用七氟烷和丙泊酚麻醉；R组采用丙泊酚和瑞芬太尼麻醉。记录2组患儿在麻醉诱导前（110）、插管2min（T1）、切皮时（T2）、手术结束时（T3）的心率、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）；记录气管插管满意率、拔管时间、术后躁动分级，以及恶心呕吐和气道并发症的发生情况。结果气管插管满意率S组（90％）与R组（83％）比较，差异无统计学意义（P〉0．05）。各时点MAP、心率的组问差异无统计学意义（P〉0．05）；R组MAP、心率在T1、T2较T0降低，差异有统计学意义（P〈0．05）；S组MAP、心率在T1、1、2与T0比较，差异无统计学意义（P〉0．05）。术后躁动者S组7例，R组2例，组间差异有统计学意义（P〈0．05）；2组均未出现恶心呕吐，以及窒息、喉痉挛等气道并发症。结论两种方法在合适麻醉深度下都可以安全的用于小儿唇腭裂修补术，七氟烷丙泊酚麻醉术后躁动的发生率较高，应注意及早给予镇痛药物；丙泊酚瑞芬太尼静脉麻醉对心率抑制较为明显。

Objective To compare the clinical efficacies and safety of sevoflurane and propofol versus remifentanil and propofol anesthesia for children with cleft lip and palate repair surgery. Methods Upon the approval of hospital ethical committee, a total of 60 pediatric patients undergoing cleft lip and palate repair surgery were recruited from two hospitals between April 2011 and December 2012. All patients were randomly divided into 2 groups （n = 30 each）. Group S：sevoflurane and propofol anesthesia; and group R： propofol and remifentanil anesthesia. Heart rate （ HR）, mean arterial pressure （MAP） and pulse oxygen saturation （SpO2 ） were recorded at the time before the induction （T0）, after 2 min of induction （TI）, the beginning of surgery （T2） and the end of surgery （ T3 ）. Intubating satisfaction, time to extubation, incidence of emergence agitation, postoperative nausea and vomiting, and the complications of the airway were recorded. Results Satisfactory intubation rate was 90% in group S, versus 83% in group R. And there was no significantly difference between the two group. There were no significantly difference between the two group with MAP and HR. Compared with TO, There were significantly difference with MAP and HR at T1, T2 in group R （ P 〈 0. 05 ）. The incidence of emergence agitation was significantly higher in group S （ 7 cases ） than that in group R （2 cases）, there were no records of nausea, vomiting and laryngospasm. Conclusion Under an adequate depth anesthesia, these two anesthesia techniques are safe for cleft lip and palate repair surgery, emergence agitation was high in sevoflurane anesthesia, propofol and remifentanil anesthesia provides lower heart rate.