七氟烷复合瑞芬太尼麻醉在小儿气管镜检术中的应用观察

Sevoflurane combined with remifentanil anesthesia for pediatric tracheal microscopic surgery.

目的观察七氟烷复合瑞芬太尼用于小儿气管镜检术的麻醉效果；并通过与目前常用麻醉方法的比较，探讨更合适的麻醉方法。方法选择40例需行气管镜检术的患儿，年龄2～5岁，随机分为七氟烷复合瑞芬太尼麻醉组（S组）、氯胺酮、丙泊酚复合小剂量维库溴铵麻醉组（K组）。术中持续监测并记录患儿SpO2、HR、BP及ECG，并观察记录手术时间、苏醒时间、术中喉痉挛和术后恶心、呕吐的发生情况。结果s组麻醉后心率、血压下降，与麻醉前相比，有统计学意义（P〈0．05）。s组麻醉后心率、血压与K组相比较低，差异有统计学意义（P〈0．05）。两组苏醒时间比较，S组较K组短，差异有统计学意义（P〈0．05）。两种麻醉方法，都有满意的肌松效果，声门显露充分，无呛咳、屏气现象。结论七氟烷复合瑞芬太尼麻醉用于小儿气管镜检术，可为手术操作提供满意的肌松条件，声门显露充分，患儿元呛咳、屏气现象，可避免置镜困难，减少声门、气道水肿及损伤，消除气管置镜引起的剧烈心血管反应；停药后可迅速苏醒，术后并发症少。

Objetive To investigate the anesthetic effect of sevoflurane combined with remifentanil in- travenous anesthesia for pediatric tracheal foreign body removal surgery; and compare the advantages and disad- vantages with the anesthetic method that is now commonly used in our department. Methods 40 children with foreign bodies in bronchial, aged 2 to 5 years old, were randomly divided into two groups： sevoflurane and remifentanil anesthesia group （ S group） ; ketamine and propofol combined with small doses of veeuronium an- esthesia group （ K group）. SpO2 , HR, NBP and ECG were continuously monitored and recorded during the operation, and the operation time, recovery time, intraoperative laryngospasm and postoperative nausea and vomiting were observed and recorded. Results There is significant difference of the heart rate and blood pres- sure before anesthesia ,before and after the tracheoseope examination in group S（ P 〈 0. 05 ）. There is significant difference of tile heart rate and hlood pressure before and after the traeheoseope examination between group S and group K（ P 〈 0. 05 ）. There is significant difference of recovery time between group S and group K（ P 〈 0.05）. The muscle relaxation effect was satisfactory, the glottis was fully exposed, and there was no cough, breath holding phenomenon in both of the anesthetic methods. Conclusion Sevoflurane combined with remifentanil intravenous anesthesia for pediatric foreign body removal surgery can provide satisfactory conditions for muscle relaxation, glottis is fully exposed, and there is no cough, breath-hold phenomenon. That also avoid the difficulty of placing the tracheoscope, reduce the glottal airway edema and injury. It could be better to re- move the severe cardiovascular response caused by tracheoscope examination and obtain stable vital signs during the operation. The children could awake quickly after stopping the anesthesia, reduce the postoperative compli- cations. It is a more effective method of anesthesia.