丙泊酚中长链脂肪乳在婴幼儿麻醉中的应用效果观察

Effect of medium and long chain triglyceride emulsion of propofol in the anesthesia of infants

目的:观察丙泊酚中长链脂肪乳在婴幼儿麻醉中的应用效果,并评价其对血流动力学、苏醒期质量以及肝功能的影响。方法:选择行择期手术的1个月至3岁患儿50例,ASAⅠ~Ⅱ级,随机分为丙泊酚中长链脂肪乳组(M组)和七氟烷组(S组),每组25例,M组和S组分别以丙泊酚中长链脂肪乳和七氟烷行麻醉诱导和维持。观察麻醉诱导前(T0)、气管插管时(T1)、术毕(T2)、拔管即刻(T3)的心率(HR)、平均动脉压(MAP);记录停药至自主呼吸恢复时间,自主呼吸恢复至拔管时间,同时记录患儿苏醒期躁动及恶心呕吐的情况;在术前、术毕和术后24 h抽取静脉血2 m L,测定丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)含量。结果:与T0相比,2组T1时刻的HR、MAP均显著降低(P<0.05);M组自主呼吸恢复至拔管的时间显著短于S组(P<0.01);M组躁动及恶心呕吐发生率显著少于S组(P<0.05~P<0.01);2组术毕及术后24 h ALT及AST与术前差异无统计学意义(P>0.05)。结论:丙泊酚中长链脂肪乳可安全用于婴幼儿麻醉,具有苏醒期躁动及恶心呕吐发生率低等优点,且短时间内手术使用并不影响肝功能。

Objective： To observe the effects of medium and long chain triglyceride emulsion of propofol in the anesthesia of infant,and evaluate its effects on hemodynamics,recovery period quality and liver function. Methods： Fifty infants with stage ASAⅠto Ⅱ,1 month to 3 years old,were randomly divided into the medium and long chain triglyceride emulsion of propofol group（ group M） and sevoflurane group（ group S）（ 25 cases each group）. The group M and S were anesthesia induced and maintained using long chain triglyceride emulsion of propofol and sevoflurane,respectively. The MAP and HR in two groups were oobserved before anesthesia induction（ T0） tracheal intubation（ T1）,at the end of operation（ T2） and tracheal extubation（ T3）. The times from stopping drug to recover pontaneous breath and from restoring breath to extubation,and restlessness,nausea and vomiting during the awakening period were recorded. The levels of ALT and AST in two groups before operation,after operation and after 24 h of operation were detected.Results： Compared with T0,the HR and MAP in two group significantly decreased at T1（ P〈0. 05）. The time from restoring breath to extubation in group M was significnatly shorter than that in group S（ P〈0. 01）. The indcience rates of restlessness,nausea and vomiting in group M were significnatly less than those in group S（ P〈0. 05 to P〈0. 01）. The differences of the levels of ALT and AST in two groups between T2 and after 24 h of operation were not statistically significant（ P〉0. 05）. Conclusions： Medium and long chain triglyceride emulsion propofol can be safely used in infants,which is low incidences rate of restlessness,nausea and vomiting during recovery period. Medium and long chain triglyceride emulsion propofol does not affect the liver function in short time surgery.