低温等离子技术行小儿腺样体切除、扁桃体消融术的麻醉管理

Anesthetic management of adenoidectomy and tonsillectomy assisted by low-temperature plasma technology in children

目的探讨耳鼻喉科应用低温等离子技术行小儿腺样体切除、扁桃体消融手术的全身麻醉管理方法。方法 2013年9-12月在解放军总医院第一附属医院择期应用低温等离子技术行腺样体切除、扁桃体消融术的患儿60例,均为ASAⅠ级,随机分为两组:静吸复合麻醉组(CIIA组,n=30),应用丙泊酚、瑞芬太尼持续泵入,复合吸入七氟醚维持麻醉;单纯静脉麻醉组(TIVA组,n=30),单纯应用丙泊酚、瑞芬太尼持续泵入维持麻醉。记录两组患儿术中血流动力学变化,苏醒拔管及送出手术室的时间,并应用小儿麻醉苏醒期躁动量化评分表(PAED)评价苏醒期躁动等情况。结果两组患儿术中血流动力学变化差异无统计学意义(P>0.05)。TIVA组丙泊酚及瑞芬太尼总用量[分别为10.5±3.4mg/(kg.h)、16.1±5.3μg/(kg.h)]均明显高于CIIA组[分别为6.6±2.8mg/(kg.h)、10.4±4.2μg/(kg.h),P<0.05]。TIVA组患儿苏醒拔管及送出手术室时间(分别为8.8±3.7min、6.2±2.9min)均明显短于CIIA组(分别为19.8±4.3min、13.7±5.2min,P<0.05)。TIVA组患儿发生苏醒期躁动的比例(1/30)明显低于CIIA组(9/30,P<0.05)。结论对于应用低温等离子技术行腺样体切除、扁桃体消融术的患儿,气管插管后仅用静脉麻醉可明显缩短苏醒时间,苏醒期躁动发生率较低,是一种安全、可行、便捷的麻醉管理方法。

Objective To explore the anesthetic management strategy in children undergoing adenoidectomy and tonsillectomy using low-temperature plasma technology. Methods Sixty ASA status I children scheduled for adenoidectomy and tonsillectomy with plasma technology in the First Affiliated Hospital of General Hospital of PLA from September to December of 2013 were enrolled in this study. After induction with propofol, sufentanil and cisatracurium, the children were randomly divided into combined inhalation and intravenous anesthesia group （CIIA group, n=30） and total intravenous anesthesia group （TIVA group, n=30）. In CIIA group, anesthesia was maintained with continuous infusion of propofol and remifentanil combined with sevoflurane inhalation during the surgery. In TIVA group, anesthesia was maintained only with continuous infusion of propofol and remifentanil. The hemodynamic changes and time for extubation and leaving operating room were recorded, and the emergence agitation was assessed using Pediatric Anesthesia Emergence Delirium （PAED） scale. Results There was no significant difference in hemodynamic changes between the two groups （P〉0.05）. The total dosages ofpropofol and remifentanil in TIVA group [10.5 ± 3.4 mg/（kg·h） and 16.1± 5.3μg/（kg·h）, respectively] were significantly higher than those of CIIA group [6.6 ± 2.8 mg/（kg·h）, 10.4± 4.2 μg/（kg.h）, P〈0.05]. The times for extubation and leaving operating room were significantly shorter in TIVA group （8.8 ± 3.7rain, 6.2± 2.9min） than in CIIA group （19.8 ± 4.3 min, 13.7 ± 5.2 min, P〈0.05）, and the rate of emergence agitation during the recovery period in TIVA group （1/30） was significantly less than that in CIIA group （9/30, P〈0.05）. Conclusion Total intravenous anesthesia with tracheal intubation could shorten the recovery time and lessen the emergence agitation during the recovery period, and it may be used as a safe, feasible and convenient anesthetic strategy for adenoidectomy and tonsillectomy with plasma technology in children.