七氟醚复合雷米芬太尼在婴儿唇腭裂整复术麻醉中的应用

Application of sevoflurane combined remifentanil anaesthesia in infants cleft lip and palate prothesis

目的比较七氟醚复合雷米芬太尼和丙泊酚复合雷米芬太尼在婴儿唇腭裂整复术中对麻醉诱导和维持、术后苏醒及并发症的影响。方法选择口腔颌面唇腭裂外科手术患儿60例，男性28例，女性32例，年龄3～12个月，其中唇裂患儿48例，腭裂患儿12例。按照美国麻醉医师协会（ASA）分级，患儿均属Ⅰ～Ⅱ级，体质量〉5kg，血红蛋白〉100g几，白细胞计数〈10．0x109／L，无心、肺、肝、肾疾患及神经、精神障碍。随机分为2组，每组30例，丙泊酚复合雷米芬太尼麻醉组（P—R组）和七氟醚复合雷米芬太尼麻醉组（S．R组）。观察并比较2组患儿诱导前（T1）、插管时（T2）、插管后即刻（T3）、插管后5min（T4）、手术开始时（T5）、手术后15min（T6）及清醒拔管时（T7）的血流动力学变化；记录意识消失时间、自主呼吸恢复时间及拔管时间，并观察术后呼吸道分泌物、躁动及恶心呕吐情况。结果术中2组患儿在T2、B、L、平均动脉压及心率方面比较差异有统计学意义（P〈0．05）；S-R组患儿意识消失时间、自主呼吸恢复时间和拔管时间均与P-R组时间相当，差异无统计学意义（P〉0．05）；S—R组术后躁动4例（13％），P—R组3例（10％），2组比较差异无统计学意义（P〉0．05）；P-R组术后呼吸道分泌物增多24例（80％），S-R组6例（20％），2组比较差异有统计学意义（P〈O．01）。结论七氟醚复合雷米芬太尼能安全、有效地用于婴儿唇腭裂整复术的麻醉，与丙泊酚复合雷米芬太尼比较，患儿血流动力学更平稳，并发症更少。

Objective To compare the anesthesia effects of sevoflurane and propofol combined remifentanil on induction or maintain,of anesthesia, postoperative recovery and complications in infants cleft lip and palate prothesis. Methods Selected 60 infants with oral and maxillofacial cleft lip surgery. They were 28 males and 32 females and aged 3 to 12 months, including cleft lip in children 48 cases, 12 cases of children with cleft palate. According to American Society of Anesthesiologists （ASA）, the infants were Ⅰ-Ⅱ grade and their weight were greater than 5 kg, hemoglobin （HGB）〉 100 g/L, white blood cells count （WBC） 〈10.0×10^9/L, without heart and lung, liver and kidney disease, and nerve mental disorders. They were divided into two groups （n=30） randomly, one group was propofol combined remifen- tanil anesthesia （P-R group）, the other was sevoflurane combined remifentanil anesthesia （S-R group）. The hemodynamic changes of infants in two groups were observed and compared at the time of before induction （T1）, intubation （T2）, after the intubation （T3）, after intubation 5 min （T4）, the start of surgery （T5）, after surgery 15 min （T6） and awake extu- bation （T7）. The time of awareness disappearance, recovery time of spontaneous breathing and the extubation time were recorded. The postoperative respiratory secretions, restlessness, nausea and vomiting were observed. Results During the surgery, the hemodynamic of S-R group was stable, but that of P-R group varied greatly in surgery. The time of awareness disappearance, recovery time of spontaneous breathing and extubation time in S-R group were almost the same as that of P-R group. The difference between two groups was no statistically significant （P〉0.05）. The postoperative agitation of S-R group was 4 cases （13%） and that of P-R group was 3 cases （10%） and they were no significant difference （P〉0.05）. The postoperative respiratory secretions increased and that of P-R group were 24 cases （80%） and 6 cases （20%） in S-R group. They were statistically significant （P〈0.05）. Conclusion Evoflurane combined remifentanil anesthesia can be used in infants cleft lip and palate prothesis safely and effectively. Compared with propofol combined remifentanil anesthesia, their hemodynamic is more stable and complications are less.