舒芬太尼复合七氟烷麻醉在小儿扁桃体或联合腺样体切除术中的应用

Application of sufentanil and sevoflurane in children undergoing tosillectomy or combined with adenoidectomy

目的观察舒芬太尼复合七氟烷麻醉用于小儿扁桃体或联合腺样体切除术的麻醉效果和对术后躁动的影响。方法择期行扁桃体或联合腺样体切除术的患儿40例，随机分为两组，每组20例。两组均以七氟烷、阿曲库铵麻醉诱导，试验组加用舒芬太尼0．2μg·kg^-1静脉注射，对照组给予氯化钠注射液。诱导插管后，术中均吸入七氟烷维持麻醉，术毕待患儿清醒后拔除气管导管。记录诱导前（T0）、气管插管时（T1）、术中剥离扁桃体或联合腺样体时（T2）、拔管时（T3）、拔管后5min（T4）患儿的心率（HR）、平均动脉压（MAP），记录手术时间、清醒拔管时间，拔管后5minRamsay镇静评分，及术后不良反应及躁动发生情况。结果试验组T3时MAP、HR水平高于Tn时（P〈0．05），其余各时点与T0时无显著差异（P〉0．05）。对照组T1～T4时MAP、HR水平均高于T0时，且高于试验组，差异均有显著意义（P〈0．05）。T4时试验组Ramsay镇静评分高于对照组（P〈0．05），两组清醒拔管时间比较无显著差异（P〉0．05），均无严重不良反应发生，试验组躁动发生率低于对照组（5％ vs．40％，P〈0．05）。结论舒芬太尼复合七氟烷麻醉可使扁桃体或联合腺样体切除术患儿围术期血流动力学更平稳，并可有效预防术后躁动的发生，且不影响苏醒时间。

AIM To investigate the anesthesia effects and the influence in agitation of sufentanil- sevoflurane in children undergoing tosillectomy or combined with adenoidectomy. METHODS Forty children undergoing surgical excision of tonsil or combined adenoid were randomly divided into two groups （20 patients in each）. In addition to sevoflurane and atracurium, sufentanil 0.2 μg·kg^-1 was given in the trial group for anesthesia induction, while sodium chloride injection in the control group. During the operation, all patients were inhaling sevoflurane to maintain anesthesia. When the patients were clear, bronchial intubation would be extracted. The levels of mean arterial pressure （MAP） and heart rate （HR） were detected before anesthesia （To）, the time of intubation （T1）, removing tonsil or adenoid （T2）, being extubated （T3） and 5 minutes after being extubated （T4）. The operating time, extubation time, and Ramsay sedation score at T4 were recorded. The incidence of adverse drug reactions and agitation were observed. RESULTS Compared with those at To, the levels of MAP and HR at T3 were higher in the trial group （P 〈 0.05）, and no significant difference at the other points （P 〉 0.05）. The levels of MAP and HR at T1 - T4 were higher than those at To in the control group （P 〈 0.05）, and higher than those at the same point in the trial group （P 〈 0.05）. The Ramsay sedation score at T4 of the trial group was higher than that of the control group （P 〈 0.05）. There were no significant difference in the extubation time between two groups （P 〉 0.05）. And no serious adverse drug reactions occurred in both groups. The incidence of agitation in the trial group was lower significantly compared with the control group （5% vs. 40%, P 〈 0.05）. CONCLUSION Combined with sufentanil and sevoflurane can maintain hemodynamic stability during perioperative period for children undergoing tosillectomy or combined with adenoidectomy, and prevent the occurrence of agitation, while not prolonging the recovery time.