七氟烷复合芬太尼在小儿斜疝麻醉中的临床研究

Clinical Effects of Sevoflurane combined Fentanyl on Anesthesia of Pediatric Ligation of Hernia Sac

目的：探讨七氟烷复合小剂量芬太尼在小儿腹股沟斜疝高位结扎术中的麻醉效果、对苏醒期的影响以及安全性。方法：选取2014年2月-2015年6月在本院行腹股沟斜疝高位结扎术的患儿120例，年龄1～6岁，ASA分级Ⅰ-Ⅱ。按照随机化的原则分为观察组和对照组，每组60例。所有患儿均给予咪达唑仑静脉诱导，自主呼吸下吸入七氟烷维持麻醉，对手术医生、护士及麻醉医师实施盲法，由专人执行观察组术前静脉注射芬太尼2μg／kg，对照组术前静脉注射同等容积的0．9％氯化钠溶液。两组均根据术中血流动力学变化和手术刺激程度，适当调控麻醉深度。比较两组患儿术中心率波动、肢体活动、苏醒期躁动及苏醒时间等，并比较两组患者低血压、喉痉挛、呼吸抑制、心动过缓等不良反应的发生情况。结果：两组患儿年龄、体质量、ASA分级等比较，差异无统计学意义（P〉0．05）；与对照组相比，观察组心率波动、肢体活动和苏醒期躁动的发生率显著降低，差异有统计学意义（P〈0．05）；两组苏醒时间和不良反应发生率比较，差异无统计学意义（P〉0．05）。结论：七氟烷复合小剂量芬太尼麻醉效果好、安全性高，术后苏醒期无躁动，适用于小儿腹股沟斜疝高位结扎术的麻醉。

Objective To investigate the effects and safety of sevoflurane combined with small dose fentanayl on anaesthesia of children underwent high hgation of indirect inguinal hernia, and its influence on stage of analepsia. Methods From February 2014 to June 2015,120 childrens aged l to 6 years old,ASA Ⅰ - Ⅱ degree,underwent high ligation of indirect inguinal hernia in our hospital, were randomly divided into observation group and control group,60 cases in each group. All children were administrated with midazolam by intravenous injection, and inhaled sevoflurane following autonomous respiration for maintaining anesthesia. The trail was blinded to surgeons, nurses and anesthesiologists. The children in two groups were given preoperative intravenous fentanyl 2 μg/kg or equal volume 0.9% sodium chloride injection, respectively. The depth of anesthesia was regulated following the changes of hemodynamics and surgical stimulation. The fluctuations of heart rate, limbs movement and the incidence of agitation in analepsia stage were compared between two groups, and the incidence of adverse reactions including low blood pressure, laryngospasm, respiratory depression and bradycardia were compared. Results The clinical data such as age,weight and ASA degree had no significant difference between two groups（ P 〉 0.05 ）. Compared with control group and the incidences of heart rate fluctuations,limbs movement and agitation were significantly decreased in observation group（ P 〈 0. 05 ）. The analepsia time and incidence of adverse reactions had no significant difference between two groups（P 〉 0.05 ）. Conclusion Sevoflurane combined small dose fentanayl is suitable for anaesthesia of children underwent high ligation of indirect inguinal hernia because of better anesthesia effects, higher safety and less restlessness.