全凭七氟醚吸入与丙泊酚静脉麻醉在小儿急性阑尾炎手术中的效果比较

The comparison of the anesthetic effect of sevoflurane inhalation and intravenous anesthesia with propofol for acute ap-pendicitis in children

目的通过对比全凭七氟醚吸入麻醉和丙泊酚静脉麻醉应用于小儿急性阑尾炎手术的麻醉效果，探讨其在小儿急性阑尾炎手术中的麻醉选择。方法选择2012年1月至2015年1月在本院接受手术的140例急性阑尾炎患儿为研究对象，随机分为七氟醚组与丙泊酚组。七氟醚组经七氟醚诱导后置入喉镜，经喉罩全凭七氟醚吸入维持麻醉，丙泊酚组以氯胺酮和丙泊酚诱导维持麻醉。记录两组患儿术中麻醉效果、血流动力学、术中及术后不良反应等指标。结果与丙泊酚组比较，七氟醚组麻醉效果更好，同时睫毛反射消失时间，疼痛反射消失时间也明显短于丙泊酚组（P＜0．05）。与手术前比较，丙泊酚组手术中的平均动脉压、心率、呼吸频率、血氧饱和度均明显降低（P＜0．05）；而七氟醚组手术中的平均动脉压、心率、呼吸频率均明显升高（P＜0．05）。七氟醚组定向力恢复时间、安全离开手术室时间明显短于丙泊酚组，同时术中出现摇头和肢体活动发生率明显少于丙泊酚组（P ＜0．05）。七氟醚组术后不良反应发生率即低血压、心率过缓明显低于丙泊酚组（P ＜0．05）。结论全凭七氟醚吸入麻醉在小儿急性阑尾炎手术中具有麻醉效果好，呼吸循环稳定及不良反应少等优点，值得临床进一步推广。

Objective To compare the anesthetic effect of sevoflurane inhalation anesthesia and intravenous se‐dation with propofol for acute appendicitis in children ,and explore the choice of anesthesia in children with acute ap‐pendicitis surgery .Methods 140 patients with acute appendicitis from January 2012 to January 2015 in our hospital were enrolled in the study ,who were randomly divided into sevoflurane and propofol group .The laryngeal mask air‐way in sevoflurane group were inserted after the induction with sevoflurane inhalation ,and maintained with sevoflu‐rane inhalation ,The children in propofol group were induced and maintained with intravenous ketamine and propofol . The anesthetic effect ,hemodynamics ,intraperative and postoperative adverse effect were recorded .Results Com‐pared with propofol group ,sevoflurane group had better anesthesia effect ,and eyelash reflex time and the pain reflex time were significantly shorter （P〈 0 .05） .Compared with before surgery ,the mean arterial pressure ,heart rate ,re‐spiratory rate and oxygen saturation of patients in the propofol group were significantly lower during the procedure （P〈 0 .05） ;while the mean arterial pressure ,heart rate and respiratory rate were significantly higher in sevoflurane group （P〈 0 .05） .The time of orientation recovery and safe departure from the operating room for sevoflurane group were significantly shorter than the propofol group ,meanwhile ,the rates of shaking head during surrgery and physical activity were significantly less than the propofol group （P〈 0 .05） .The incidence of adverse effect including hypoten‐sion and bradycardia in the propofol group was significantly higher than in the sevoflurane group （P〈 0 .05） .Conclu‐sion The sevoflurane anesthesia has better anesthetic effect ,respiratory and circulatory stability ,and less adverse effect in children with acute appendicitis surgery ,which is worthy of further promotion .