靶控输注异丙酚和异丙酚复合瑞芬太尼镇静在小儿埋伏多生牙拔除手术中应用的比较

Comparison between propofol and propofol-remifentanil sedation under target-controlled infusion for impacted supernumerary teeth extraction surgery for children

目的对靶控输注异丙酚和异丙酚复合瑞芬太尼2种镇静方法在小儿埋伏多生牙拔除手术中的应用进行比较。方法将60例接受上前牙区埋伏多生牙拔除术的患儿随机分为2组:异丙酚组(P组,n=30)和异丙酚复合瑞芬太尼组(PR组,n=30)。P组:滴定法靶控输注异丙酚至改良OAA/S评分3分时进行手术。PR组:靶控输注瑞芬太尼目标浓度为1 ng·mL-1,滴定法靶控输注异丙酚至改良OAA/S评分3分时进行手术。采用Houpt行为治疗效果评分评估2组患儿术中配合情况,记录2组患儿心率、血压、血氧饱和度、呼吸频率和Narcotrend指数(NI),以及相关并发症、不良反应及药物输注情况。结果 Houpt行为治疗效果评分PR组优于P组(P<0.05)。血氧饱和度、呼吸频率PR组低于P组(P<0.05),心率、血压及NI值2组无统计学差异(P>0.05)。呼吸抑制和顺行性遗忘的发生率,PR组高于P组(P<0.05)。结论在小儿埋伏多生牙拔除术中,靶控输注异丙酚和靶控输注异丙酚复合瑞芬太尼镇静这2种方法都是安全有效的。在吸氧状态下,靶控输注异丙酚复合瑞芬太尼镇静优于异丙酚镇静。

Objective The aim of this study is to compare sedation titrated under target-controlled infusion ofpropofol and propofol-remifentanil for impacted supernumerary teeth extraction surgery for children. Methods A total of 60 children with anterior maxillary region impacted supernumerary teeth extraction surgery were divided randomly into two groups, namely, propofol group （group P, n=30） and propofol-remifentanil group （group PR, n=30）. In group P, a titrated infusion of propofol was started until the modified observer＇s assessment of alertness/sedation （OAA/S） scale reached level 3 before the actual surgery. In group PR, a remifentanil infusion with a target plasma concentration of 1 ng＇mL-t was started until the operation was finished. A titrated infusion of propofol was also started until the modified OAA/S score reached level 3 before the actual surgery. The Houpt behavior scale was adopted to evaluate the cooperation of each patient in both groups. The heart rate, blood pressure, respiratory rate, oxyhemoglobin saturation, and Narcotrend index, complications, adverse reactions and propofol infusion of all patients were recorded during the operation. Results The Houpt behavior scales in group PR were better than those in group P （P〈0.05）. The oxyhemoglobin saturation and respiratory rate in group PR were lower than that in group P （P〈0.05）. The heart rate, blood pressure and NI in two groups were no significant difference （P〉0.05）. The incidence of respiratory depression and anterograde amnesia in group PR were higher than that in group P （P〈0.05）. Conclusion Sedation titrated under the target-controlled infusion of propofol and that titrated under propofol-remifentanil for impacted super- numerary teeth extraction surgery for children are safe. The sedation titrated under target-controlled infusion of propofolremifentanil is better than sedation by propofol when inhaling oxygen.