不同镇痛麻醉药物在儿童扁桃体及腺样体切除术中的麻醉效果比较

Comparison of anesthetic effect of different anesthetic drugs in the pediatric tonsilloadenoiectomy

目的探讨瑞芬太尼、舒芬太尼、芬太尼三种药物用于儿童扁桃体、腺样体切除术的麻醉效果差异。方法选择我院2016年3月—2017年2月接受扁桃体、腺样体切除术的210例患儿作为研究对象,随机将患儿分为瑞芬太尼组、舒芬太尼组和芬太尼组,每组70例。瑞芬太尼组以瑞芬太尼1 mg/kg诱导,术中以0.1 mg·kg^(-1)·min^(-1)维持,手术结束前5 min停药;舒芬太尼组以舒芬太尼0.2 mg/kg诱导,术中以0.1 mg·kg^(-1)·h^(-1)维持,手术结束前30 min停药;芬太尼组以芬太尼2 mg/kg诱导,术中以1μg·kg^(-1)·h^(-1)维持,手术结束前30 min停药。麻醉过程中记录3组患儿的心率(HR)、平均动脉压(MAP)和血氧饱和度指标;记录诱导后患儿的睫毛反射消失时间、疼痛反应消失时间、术后睁眼时间和拔管时间;术后对比分析3组患儿围手术期不良反应的发生率。结果瑞芬太尼组HR、MAP在麻醉诱导、麻醉5 min、麻醉10 min高于舒芬太尼组和芬太尼组(P<0.05),而舒芬太尼组和芬太尼组各时间点HR、MAP差异无统计学意义(P>0.05)。芬太尼组的疼痛反应消失时间、睁眼时间和拔管时间均长于瑞芬太尼组和舒芬太尼组(P<0.05),而后2组的疼痛反应消失时间、睁眼时间和拔管时间差异无统计学意义(P>0.05)。瑞芬太尼组术后躁动发生率高于舒芬太尼组和芬太尼组(P<0.01),而后2组术后躁动发生率差异无统计学意义(P>0.05)。结论在儿童扁桃体、腺样体切除术麻醉中,舒芬太尼复合全麻效果优于瑞芬太尼和芬太尼,具有起效快、苏醒快、术中血流动力学稳定及术后躁动发生率低的优点。

Objective To investigate different anesthetic effects of remifentanil,sufentanil,and fentanyl in the pediatric tonsilloadenoiectomy.Methods Totally210cases of tonsilloadenoiectomy enrolled in our institution from March2016to February2017were selected as study objects.Children were divided randomly into three groups,with70cases in each group,including remifentanil group,sufentanil group,and fentanyl group.Child patients in the remifentanil group were induced by remifentanil with1mg/kg,and were maintained with0.1mg·kg-1·min-1.Remifentanil was withdrawn5minutes before the end of operation.Child patients in the sufentanil group were induced by sufentanil with0.2mg/kg,and were maintained with0.1mg·kg-1·h-1.Sufentanil was withdrawn30minutes before the end of operation.Child patients in the fentanyl group were induced by fentanyl with2mg/kg,and were maintained with1mg·kg-1·h-1.Fentanyl was withdrawn30minutes before the end of operation.During the anesthesia,the indexes of heart rate(HR),mean arterial pressure(MAP),and oxygen saturation were recorded in the three groups.The time of eyelash reflex disappearance,pain reflex disappearance,postoperation eye open,and extubation were also recorded.The incidences of perioperative adverse events were compared between the three groups.Results HR and MAP at time points of anesthesia induction,5minutes after anesthesia induction,and10minutes after anesthesia induction were higher in the remifentanil group than those in the other two groups(P<0.05).And the differences of the above indexes at all time points between sufentanil group and fentanyl group showed no statistical significance(P>0.05).The time of pain reflex disappearance,postoperation eye open,and extubation were higher in the fentanyl group than those in the other two groups(P<0.05).And the differences of the above indexes between sufentanil group and remifentanil group showed no statistical significance(P>0.05).Incidence rate of postoperative agitation was higher in the remifentanil group than that in the other two groups(P<0.01).And the difference of incidence rate of postoperative agitation between the sufentanil group and fentanyl group showed no statistical significance(P>0.05).Conclusion The effect of sufentanil is better than remifentanil and fentanyl in the anesthesia of pediatric tonsilloadenoiectomy,with fast effect,fast analepsia,stable haemodynamics,and low incidence rate of postoperative agitation.