瑞芬太尼在小儿静吸复合全麻中的应用效果观察

The clinical observation of remifentanil in pediatric inhalation anesthesia

目的观察瑞芬太尼用于小儿静吸复合全麻的临床疗效和安全性。方法选择本院2009年1月～2013年1月收治入院的ASAⅠ～Ⅱ级患儿200例,随机分为两组,A组100例采用瑞芬太尼静吸复合全麻,B组100例采用芬太尼静吸复合全麻。记录患儿入室(T1)、麻醉诱导给药结束(T2)、气管插管(T3)、切皮(T4)、拔除气管导管(T5)、离室(T6)时的心率(HR)、收缩压(SBP),并观察两组苏醒时间(手术结束至气管导管拔除时间)及不良反应情况。结果 A组T5、T6时HR明显高于B组(P<0.05),T2、T5、T6时A组SBP明显高于B组(P<0.05)。A组内,T5、T6时HR明显高于前面各时间点(P<0.05);T4时SBP较前面各时间点明显降低(P<0.05),T5、T6时SBP较前面各时点明显升高(P<0.05);T5时SBP较T2、T4明显升高(P<0.05);A组躁动发生率明显高于B组(P<0.05)。结论瑞芬太尼静吸复合全麻可使患儿血压、心率维持在稳定的低水平状态。

Objective To observe the clinical effect and safety of remifentanil in pediatric inhalation anesthesia. Methods 200 children with ASA Ⅰ-Ⅱ admitted into our hospital from January 2009 to January 2013 were selected. They were evenly divided into two groups： group A and group B. In group A, remifentanil in pediatric inhalation anesthesia was applied, while in group B, propofol was used. The indicators like heart rate （HR）, systolic blood pressure （SBP） in the time of entering operation room （T1 ）, ending anesthesia induction of drug administration （T2 ）, trachea cannula （T3 ）, skin incision （T4 ）, removing tracheal catheter （T5 ）, and sending out operation room （T6 ） was recorded, and then awakening time（referring from surgery terminating to tracheal catheter removing） and adverse reaction were observed. Results The HR in group A during T5 and T6 was obviously faster than that in group B （P＆lt;0.05）. The SBP in group A during T2 , T5 and T6 was higher than that in group B （P＆lt;0.05）. In the same group A, the HR and SBP during T5 and T6 were increased greater compared with the rest four periods （P＆lt;0.05）. At the same time, the SBP during T4 was greatly lower than the first three periods （P＆lt;0.05）, but the SBP in T5 was increased higher compared with that in T2 and T4 （P＆lt;0.05）. The occurrence rate of restlessness in group A was remarkably higher than that in group B （P＆lt;0.05）. Conclusion The remifentanil inhalation anesthesia in children can maintain blood pressure and heart rate in a stable low level.