七氟烷吸入麻醉与异丙酚静脉麻醉对疝气手术患儿血流动力学、应激反应及麻醉效果的影响

Influence of Sevoflurane Inhalation Anesthesia and Propofol Intravenous Anesthesia on Hemodynamics,Stress Reaction and Anesthesia Effects of Pediatric Hernia Surgery

目的:探讨七氟烷吸入麻醉与异丙酚静脉麻醉对疝气手术患儿血流动力学、应激反应及麻醉效果的影响。方法:选取2011年5月-2015年9月于湖北省第三人民医院接受疝气手术的86例患儿为研究对象,采用随机数字表法分为试验组和对照组,各43例。试验组患儿给予注射用盐酸替罗非班0.4μg/(kg·min),ivgtt,注射用苯磺顺阿曲库铵0.1 mg/kg+枸橼酸芬太尼注射液1.0μg/kg,iv,进行麻醉诱导;吸入用七氟烷2%~3%进行麻醉维持,必要时追加枸橼酸芬太尼注射液0.5μg/kg,iv。对照组患儿给予异丙酚乳状注射液3 mg/kg+注射用苯磺酸阿曲库铵0.1 mg/kg+枸橼酸芬太尼注射液1.0μg/kg,iv,进行麻醉诱导;丙泊酚注射液3 mg/(kg·h)微泵注入进行麻醉维持,必要时追加枸橼酸芬太尼注射液0.5μg/kg,iv。观察两组患儿麻醉起效时间、血流动力学指标[收缩压(SBP)、舒张压(DBP)和心率(HR)]、应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)和肾素(R)]、苏醒情况,并记录不良反应发生情况。结果:试验组患儿麻醉起效时间为(3.82±0.45)min,明显短于对照组的(5.13±0.74)min,差异有统计学意义(P<0.05)。麻醉诱导前,两组患儿SBP、DBP、HR和血清NE、E、R水平比较,差异均无统计学意义(P>0.05)。切皮即刻、切皮后5 min、切皮后10 min时,两组患儿SBP、DBP、HR水平均明显高于麻醉诱导前,差异均有统计学意义(P<0.05);切皮即刻、切皮后5 min时,试验组上述指标明显低于对照组,差异均有统计学意义(P<0.05)。切皮即刻时,两组患儿血清NE、E、R水平均较麻醉诱导前明显升高,但试验组明显低于对照组,差异均有统计学意义(P<0.05)。试验组患儿术后的睁眼时间、清醒时间、定向力恢复时间均明显短于对照组,苏醒期躁动量化评分明显低于对照组,差异均有统计学意义(P<0.05)。试验组患儿不良反应发生率(0)明显低于对照组(11.6%),差异有统计学意义(P<0.05)。结论:七氟烷吸入麻醉较异丙酚静脉麻醉对疝气手术患儿的血流动力学指标影响小,有助于缓解应激反应、促进术后苏醒,且安全性较好。

OBJECTIVE:To investigate the influence of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on hemodynamics,stress reaction and anesthesia effects of pediatric hernia surgery.METHODS:Eight-six children underwent hernia surgery in Hubei Provincial Third People’s Hospital from May2011to Sept.2015were selected as subjects and divided into trial group and control group according to random number table,with43cases in each group.Trial group was given Tirofiban hydrochloride for injection0.4μg/(kg·min),ivgtt,Cisatracurium besilate for injection0.1mg/kg+Fentanyl citrate injection1.0μg/kg,iv,for anesthesia induction;given2%-3%sevoflurane inhalation for anesthesia maintenance,and additionally given fentanyl citrate0.5μg/kg,iv if necessary.Control group was given Propofol emulsion injection3mg/kg+atracurium0.1mg/kg+fentanyl citrate1.0μg/kg,iv for anesthesia induction;given micro pump injection of propofol3mg/(kg·h)for anesthesia maintenance,and additionally given fentanyl citrate0.5μg/kg,iv if necessary.The onset time of anesthesia,hemodynamic parameters(SBP,DBP,HR),stress reaction indexes(NE,E,R),recovery situation and the occurrence of ADR were observed in2groups.RESULTS:The onsettime of anesthesia in trial group was(3.82±0.45)min,significantly shorter than control group(5.13±0.74)min,with statistical significance(P<0.05).Before anesthesia induction,there was no statistical significance in SBP,DBP,HR,the serum levels of NE,E and R between2groups(P>0.05).The levels of SBP,DBP,HR of2groups at incision,5min after incision,10minafter incision were significantly higher than before anesthesia,with statistical significance(P<0.05).Above indexes of trial group at incision,5min after incision were significantly lower than control group,with statistical significance(P<0.05).At incision,the serum levels of NE,E and R in2groups were increased significantly compared to before anesthesia induction,but the trialgroup was significantly lower than the control group,with statistical significance(P<0.05).The postoperative eye opening time,awake time and orientation recovery time of trial group were significantly shorter than control group,while the PAED score was significantly lower than control group,with statistical significance(P<0.05).The incidence of ADR in trial group(0)was significantly lower than control group(11.6%),with statistical significance(P<0.05).CONCLUSIONS:Sevoflurane inhalation anesthesia has less effect than propofol intravenous anesthesia on hemodynamic indexes and is helpful to relieve stress reaction and promote postoperative revival with good safety.