七氟醚或丙泊酚复合瑞芬太尼用于小儿经喉罩纤维支气管镜检查的比较

Comparison of Sevoflurane or Propofol combined with Remifentanil in pediatric fiberoptic bronchoscopy via laryngeal mask airway

目的观察和比较七氟醚或丙泊酚复合瑞芬太尼麻醉在小儿经喉罩纤维支气管镜(FOB)检查中的临床效果。方法 60例拟行FOB检查的患儿随机分为两组,每组30例:七氟醚复合瑞芬太尼组(S组)和丙泊酚复合瑞芬太尼组(P组)。S组采用七氟醚复合瑞芬太尼的静吸复合麻醉方式,P组采用丙泊酚复合瑞芬太尼的全凭静脉麻醉方式。两组均置入喉罩并保留自主呼吸,经喉罩行FOB检查。记录入室后安静时(T0:基础值)、镜检前(T1)、镜检进行2 min(T2)时平均动脉压(MAP)、心率(HR)、脉氧饱和度(Sp O)2、呼气末二氧化碳(PETCO2)和脑电双频指数(BIS),评估麻醉效果,并记录镜检时间、苏醒时间和不良反应发生情况。结果 P组T1时HR、MAP和Sp O2明显低于S组、PETCO2明显高于S组;T2时MAP、HR和PETCO2明显高于S组、Sp O2明显低于S组(P<0.05)。S组麻醉效果优良率明显高于P组(P<0.05)。S组短暂呼吸抑制、检查中断率明显低于P组(P<0.05)。结论经喉罩吸入七氟醚复合静脉瑞芬太尼用于小儿FOB检查,较丙泊酚复合瑞芬太尼的全凭静脉麻醉方式更为安全、有效。

Objective To assess the efficacy of Sevoflurane-Remifentanil anesthesia in pediatric fiberoptic bronchoscopy（FOB） compared with a Propofol-Remifentanil regimen. Methods 60 children scheduled for fiberoptic bronchoscopy were randomly divided into two groups（n = 30 in each group）： In group S, patients received Sevoflurane inhalation and intravenous infusion with Remifentanil. In group P, patients received total intravenous anesthesia with Propofol and Remifentanil. Standard laryngeal mask airways（LMA） were inserted into all children in two groups after anesthesia and fiberoptic bronchoscopy was carried out via LPA. MAP, HR, Sp O2, PETCO2 and BIS were recorded before anesthesia（T0, baseline）, before FOB（T1）, 2 min after FOB（T2）. Then assess the effect of general anesthesia. Procedure time, recovery time and incidence of adverse events were also recorded. Results HR, MAP and Sp O2 at T1and Sp O2 at T2in group P were significantly lower than those in group S. PETCO2 at T1and MAP, HR, PETCO2 at T2in group P were significantly higher than those in group S. Better quality of anesthesia, less respiratory depression,and less interruption needed during procedure were found in group S. Conclusion Compared with Propofol-based total intravenous anesthesia, Sevoflurane inhalation via laryngeal mask combined with intravenous Remifentanil pro-vides a superior profile in pediatric fiberoptic bronchoscopy.