七氟醚复合芬太尼在幼儿眼科手术中的临床应用

Application of sevoflurane combined with fentanyl in children with operation of ophthalmology

目的 比较七氟醚单独与复合不同浓度芬太尼用于幼儿眼科手术的临床疗效。方法 将80例择期拟在全麻下行麦粒肿手术的患儿（年龄24～72个月）,随机分为4组,每组20例。七氟醚组（S组）给予生理盐水诱导,七氟醚芬太尼1组给予芬太尼2μg/kg诱导（SF1组）,七氟醚芬太尼2组给予芬太尼4μg/kg诱导（SF2组）,七氟醚芬太尼3组给予芬太尼6μg/kg诱导（SF3组）。观察并记录患儿诱导前（T0）、插管前（T1）、插管即刻（T2）的心率、血氧饱和度、BIS值、MAC值、术后苏醒时间,评价出手术室时、入苏醒室10 min及离开PACU时的躁动分级（Z1、Z2、Z3）,记录在PACU停留的时间和恶心呕吐的发生率。结果 所有研究对象在PACU均无恶心呕吐的发生,且均在30 min后安全回到病房。治疗前后比较各组心率差异有统计学意义（P〈0.05）,各组诱导时间和手术时间比较差异无统计学意义（P〉0.05）。但苏醒时间比较差异有统计学意义（P〈0.05）：S组SF1组〉SF2组。S组和SF1组入PACU 10 min和出PACU的躁动率高于SF2组,差异有统计学意义（P〈0.125）,S组和SF1组比较差异无统计学意义（P〉0.125）。SF3组共做3例,但3个研究对象的苏醒时间均在20 min以上,在PACU停留时间达1 h,综合考虑,舍弃SF3组。结论 与单独使用七氟醚相比,给予芬太尼可以更好地维持循环稳定,并且予患儿4μg/kg芬太尼,可以明显降低术后躁动率。

Objective To compare the effect of sevoflurane combined with fentanyl on children with operation of ophthalmology. Methods Eighty children （24 ～72 months） undergoing sty surgery were randomly divided into 4 groups. Patients in group S, group SF1, group SF2 and group SF3 were given induction anesthesia of physiological saline 5 mL, fentanyl 2μg/kg, fentanyl 4 μg/kg and fentanyl 6 μg/kg. The heart rate was recorded before induction （ To ）, before intubation （ T1 ） and at the time point of intubation （ T2 ）. The SpO2, BIS value, MAC value and postoperative recovery time were assessed. The agitation degree at the time points of waking up （ Z1 ） , 10 rain after entering PACU （Z2） and leaving PACU （Z3） was recorded. The residence time in PACU and the incidence of nausea/vomiting were assessed. Results No nausea, vomiting reaction case occurred, the patients all returned to the ward after 30 min. There was significant difference in heart rate before and after operation （ P 〈 0. 05 ）. No significant difference was observed in induction time and operation time （ P 〉 0. 05 ） among the groups. There was significant difference in the recovery time （ group S 〈 group SF1 〈 group SF2, P 〈 0. 05 ） and agitation rate （ group S 〉 group SF1 〉 group SF2, P 〈0. 05）. The Z2 and Z3 in group S and group SF1 were higher than those of group SF2 （ P 〈0. 125 ）, while there was no significant difference between group S and group SF1 （ P 〉 0. 125 ）. There were three subjects in group SF3, however, the recovery time was over 20 min and the residence time was more than 1 h in PACU, therefore, the group was abandoned. Conclusion Compared with sevoflurane alone, sevoflurane combined with fentanyl can maintain a stable circulation,4μg/kg fentanyl can effectively reduce the incidence of emergence agitation.