瑞芬太尼复合喷他佐辛在腔镜小儿疝手术麻醉中应用效果观察

Effect observation of application of remifentanil and pentazocine during anesthesia in pediatric laparoscopic hernia

目的：观察瑞芬太尼复合喷他佐辛的麻醉方法在腔镜小儿疝手术手术中应用效果,与其他三种不同的麻醉方法比较,旨在为该类手术选择适宜的麻醉方法。方法：选择行腔镜小儿疝囊高位结扎术80例,ASAⅠ或Ⅱ级,年龄1~6岁,随机分成4组：丙泊酚-瑞芬太尼组（PR组）,丙泊酚-瑞芬太尼-喷他佐辛组（PRP组）,丙泊酚-氯胺酮组（PK组）,丙泊酚-芬太尼组（PF组）。记录各组拔管时间、苏醒时间、拔管即刻（T1）、拔管后3 min（T2）、拔管后5 min（T3）、拔管后10 min（T4）的Ramsay镇静评分,平均动脉压（MAP）、心率（HR）以及患者术后24 h呼吸抑制、恶心、呕吐等不良反应。结果：与PR组相比,其余3组T1~T4的Ramsay评分升高,MAP、HR下降,差异有统计学意义（P〈0.05）;与PR、PRP组比较,PK、PF组苏醒时间延长,差异有统计学意义（P〈0.05）;与PR、PRP、PK组比较,PF组拔管时间延长,术后呼吸抑制不良反应发生率高,差异有统计学意义（P〈0.05）。与PR、PRP、PF比较,PK术后恶心、呕吐反应发生率高,差异有统计学意义（P〈0.05）。结论：瑞芬太尼-喷他佐辛复合麻醉应用于腔镜小儿疝手术,患儿术后苏醒快,拔管后躁动少,血流动力学平稳,不良反应少,适宜于此类手术。

Objective Pentazocine remifentanil anesthesia application effects observed in pediatric laparoscopic hernia surgery, compared with the other three different methods of anesthesia,aimed to select the appropriate method for the type of surgical anes-thesia.Method 80 cases of elective pediatric laparoscopic hernia sac ligation were selected,ASAⅠorⅡ,aged 1 to 6 years old,were randomly divided into four groups：propofol -remifentanil group （PR group）,propofol -remifentanil -pentazocine group （PRP group）,propofol -ketamine （PK group）,propofol -fentanyl group （PF group）.Each group：extubation time,recovery time,extu-bation （T1 ）,after extubation 3min （T2 ）,after extubation 5min （T3 ）,10 minutes after extubation （T4 ）of Ramsay sedation score, mean arterial pressure （MAP）,heart rate （HR）,and 24 hours postoperative respiratory depression,nausea,vomiting and other ad-verse reactions.Results PR group compared with the other three groups of T1 ~T4 Ramsay score increased,MAP,HR decreased significantly （P 〈0.05）;and PR,PRP group,PK,PF group prolonged recovery time difference there was statistically significant （P〈0.05）;and PR,PRP,PK group,PF group extubation prolonged postoperative respiratory depression incidence of adverse reac-tions,the difference was statistically significant （P 〈0.05）.Compared with PR,PRP,PF,PK postoperative nausea,vomiting high incidence,the difference was statistically significant （P 〈0.05）.Conclusion Remifentanil -pentazocine complex pediatric anes-thesia in laparoscopic hernia surgery,children wake up fast,less restless after extubation,stable hemodynamics,fewer adverse reac-tions,suitable for such surgery.