不同麻醉维持方式对小儿OSAS手术后苏醒期躁动影响比较

Effect of different anesthesia maintenance modes on children emergence agitation after OSAS surgery:a study of comparison

目的：探讨瑞芬太尼复合异丙酚全凭静脉麻醉与瑞芬太尼复合七氟醚静吸复合麻醉对阻塞性睡眠呼吸暂停综合征（ OSAS）患儿苏醒期躁动（ EA）的影响。方法选择40例4～11岁择期行扁桃体切除和（或）腺样体刮除手术的患儿，随机分为全凭静脉麻醉（I）组与静吸复合麻醉组（S）组，每组20例。2组均以咪唑安定0．1 mg/kg，瑞芬太尼1μg/kg，异丙酚1．5～2 mg/kg，和罗库溴铵0．6 mg/kg麻醉诱导插管，I组麻醉维持应用瑞芬太尼0．4～0．5μg· kg-1· min-1＋异丙酚4～6 mg· kg-1· h-1，手术结束同时停止输注。 S组麻醉维持以瑞芬太尼0．4～0．5μg· kg-1· min-1＋吸入七氟醚1．2～1．8 MAC，手术结束同时停药。 EA按照5点法进行评估。结果 I组EA评分平均低于S组（P＜0．05），EA发生率（25％）明显低于S组（60％）。结论 OSAS手术患儿瑞芬太尼异丙酚全凭静脉麻醉后EA的发生率低于七氟醚异丙酚静吸复合麻醉。

Objective To compare the effect of remifentanil-propofol total intravenous anesthesia and remifentanil -sevoflurane inhalation-intravenous balanced anesthesia over emergence agitation （ EA） of children with obstructive sleep apnea syndrome（OSAS） during anesthesia recovery .Methods 40 children aged 4 to 11 years old undergoing selective tonsillectomy and （or） adenoidectomy were allocated randomly into two groups （20 cases each）：the total intravenous anesthesia group （I group） and the inhalation-intravenous balanced anesthesia group （S group）.The induced anesthesia was performed with mid-azolam 0.1mg/kg,remifentanil 1μg/kg,propofol 1.5~2 mg/kg, and rocuronium 0.6mg/kg in both groups.Anesthesia was maintained as follows：in I group with remifentanil 0.4~0.5 μg· kg-1 · min-1 ＋propofol 4~6 mg· kg-1 · h-1;in S group with remifentanil 0.4~0.5μg· kg-1 · min-1 ＋sevoflurane 1.2~1.8MAC.The anesthesia was withdrawn simultaneously by the end of operation.5 point method was used to assess EA.In I group, the average EA score was lower than that in S group （P〈0.05）;the incidence rate of EA （25%） was significantly lower than that in S group （60%）.Conclusion The balanced anesthesia can reduce the incidence rate of EA of OSAS surgery during anesthesia recovery in children than the total intrave -nous anesthesia .