苏芬太尼联合丙泊酚用于小儿麻醉的临床观察

Analysis of the clinical value of sufentanil combined with propofol in the treatment of anesthesia in children

目的 观察苏芬太尼与丙泊酚联合用于小儿麻醉诱导期的临床效果.方法 选取72例手术治疗的患儿,采用完全随机分配法分为三组,观察组A、观察组B和对照组,各24例.观察组A静脉输注苏芬太尼0.01 μg·kg^-1·min^-1,观察组B静脉输注苏芬太尼0.02 μg·kg^-1·min^-1,对照组给予0.9％氯化钠注射液静脉滴注,30 min后给予丙泊酚靶控输注.记录三组患儿的脑电双频指数（BIS）、丙泊酚效应室浓度（EC）、OAA/S评分和麻醉诱导（LOC）时间.结果 三组患儿的BIS与丙泊酚EC及OAA/S评分均具有较好的相关性,BIS与丙泊酚EC之间呈负相关（r=-0.82、-0.79、-0.88,均P＜0.01）,BIS与OAA/S评分呈正相关（r=0.86、0.81、0.89,均P＜0.01）.与对照组的LOC时间[（9.11±1.04）min]相比,观察组A、B的LOC时间明显缩短[（5.37±0.89） min、（4.49±0.63）min]（t=13.39、18.61,均P＜0.01）;与麻醉诱导期间对照组的丙泊酚EC （2.44±0.5） μg/mL相比较,观察组A、B的丙泊酚EC明显降低降低[（1.38±0.35）、（1.14±0.27） μg/mL],差异有统计学意义（t=8.40、11.04,均P＜0.01）,且观察组B的效果均优于观察组A（t=3.95、2.67,均P＜0.05）.观察组A的BIS值（70±4）,与对照组（69±7）差异无统计学意义（t=0.61,P＞0.05）;观察组B的BIS（78±5）,显著高于观察组A和对照组（t=6.12、5.13,均P＜0.01）.结论 苏芬太尼与丙泊酚联合用于小儿麻醉有协同作用,有利于减少麻醉诱导期间一定量的丙泊酚EC,缩短LOC时间,增强丙泊酚的镇静作用,值得临床进一步推广应用.

Objective To explore the clinical value of combined treatment of sufentanil and propofol in children during anesthesia induction.Methods 72 children were selected,and they were randomly divided into three groups by full random allocation method：observation group A,observation group B and control group,24 cases in each group.The observation group A was given intravenous infusion of sufentanil（0.01g · kg^-1 · min^-1）,the observation group B was given intravenous infusion of sufentanil （0.02g · kg^-1 · min^-1）,the control group was given intravenous saline infusion,then given propofol target controlled infusion after 30min.The bispectral index （BIS）,propofol effect chamber （EC）,OAA/S score and time of induction of anesthesia （LOC） time were recorded in the three groups.Results There was a significant correlation between BIS and propofol EC and OAA/S scores in the three groups,and there was a negative correlation between BIS and propofol EC （r =-0.82,-0.79,-0.88,all P 〈 0.01）.BIS and OAA/S score was positively correlated （r =0.86,0.81,0.89,all P 〈 0.01）.Compared with the control group [（9.11 ± 1.04） min],the LOC time of the observation group A and B [（5.37 ± 0.89） min,（4.49 ± 0.63） min] was significantly shortened （t =13.39,18.61,all P 〈 0.01）.The propofol EC of control group was （2.44 ± 0.5） μg/mL,the propofol EC of the observation group A and B [（1.38 ± 0.35） μg/mL,（1.14 ± 0.27） μg/mL] decreased during anesthesia induction （t =8.40,11.04,all P 〈 0.01）,and the effect of the observation group B was better than that of the observation group A （t =3.95,2.67,all P 〈 0.05）.There was no statistically significant difference in BIS between the observation group A and control group [（70 ± 4） vs.（69 ± 7）,t =0.61,P 〉 0.05].The BIS of observation group B （78 ± 5） was significantly higher than that of the observation group A and control group （t =6.12,5.13,all P 〈 0.01）.Conclusion Sufentanil combined with propofol for anesthesia in children has a synergistic effect,which is beneficial to reduce the amount of propofol EC during anesthesia induction,shorten the time of LOC and enhance the sedative effect of propofol,and it is worthy of further clinical application.