舒芬太尼复合静脉麻醉在小儿泌尿外科手术中的效果观察

Effect observation of sufentanil combined with intravenous anesthesia in pediatric urological surgery

目的观察舒芬太尼复合静脉麻醉在小儿泌尿外科手术中的临床效果。方法回顾性选取2017年1月-2020年3月福建省厦门市第五医院收治的泌尿外科手术患儿103例,按照麻醉方法不同分为观察组53例和对照组50例。观察组行舒芬太尼复合静脉麻醉,对照组行芬太尼复合丙泊酚静脉麻醉。比较2组各时点血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]、围术期指标、简易精神状态量表(MMSE)评分、视觉模拟疼痛量表(VAS)评分及不良反应。结果入室时(T_(0))时,2组HR、MAP及SpO_(2)比较差异均无统计学意义(P> 0.05);麻醉诱导5 min后(T_(1))、切皮时(T_(2))时,2组HR及MAP均高于T;时,但观察组HR及MAP均低于对照组(P<0.05);T_(1)、T_(2)时,2组SpO_(2)比较差异均无统计学意义(P> 0.05);手术结束时(T_(2))时,2组HR、MAP及SpO_(2)比较差异均无统计学意义(P> 0.05)。观察组手术时间、术后复苏时间均短于对照组,麻醉药追加剂量少于对照组(P<0.05)。苏醒后,观察组定向能力、回忆能力、语言能力、计算与注意能力、记忆能力评分与术前比较差异均无统计学意义(P>0.05);苏醒后,对照组定向能力、回忆能力、语言能力、计算与注意能力、记忆能力评分均低于术前及观察组(P<0.05)。观察组苏醒即刻、术后1 h、术后3 h、术后6 h、术后12 h VAS评分均低于对照组(P<0.01)。观察组不良反应总发生率为5.66%,低于对照组的20.00%(χ^(2)=4.797,P=0.029)。结论小儿泌尿外科手术中采用舒芬太尼复合静脉麻醉的效果较好,在稳定血流动力学指标同时,可减少麻醉追加剂量,促使患儿术后更快苏醒,减少不良反应,减轻对患儿认知功能的影响,减轻患儿疼痛,安全性较高,值得推广。

Objective To observe the clinical effect of sufentanil combined with intravenous anesthesia in pediatric urological surgery.Methods Retrospectively selected 103 children undergoing urological surgery admitted to the Fifth Hospital of Xiamen City, Fujian Province from January 2017 to March 2020. According to different methods of anesthesia, they were divided into observation group 53 cases and control group 50 cases. The observation group received sufentanil combined with intravenous anesthesia, and the control group received fentanyl combined with propofol intravenous anesthesia. Compared the hemodynamic indicators[heart rate(HR), mean arterial pressure( MAP), blood oxygen saturation( SpO_(2))], perioperative indicators, mini mental state scale(MMSE) scores, visual analog pain scale(VAS) score and adverse reactions of two groups.Results At T_(0), there were no significant difference in HR, MAP and SpO_(2)between the two groups(P> 0. 05);At T_(1), T_(2),the HR and MAP of the two groups were higher than those at T;, but the HR and MAP of the observation group were lower than those of the control group(P< 0. 05);At T_(1)and T_(2), there were no statistically significant difference in SpO_(2)between the two groups(P> 0. 05);At T_(0), there were no significant difference in HR, MAP and SpO_(2)between the two groups(P>0. 05). The operation time and postoperative resuscitation time of the observation group were shorter than those of the control group, and the additional dose of anesthesia was less than that of the control group(P< 0. 05). After awakening, the observation group had no significant difference in orientation ability, recall ability, language ability, calculation and attention ability,and memory ability scores compared with those before operation(P> 0. 05);After awakening, the scores of orientation ability,recall ability, language ability, calculation and attention ability, and memory ability of the control group were lower than those of the preoperative and observation group(P< 0. 05). The VAS scores of the observation group immediately after awakening,1 hour after operation, 3 hours after operation, 6 hours after operation, and 12 hours after operation were lower than those of the control group(P< 0. 01). The total incidence of adverse reactions in the observation group was 5. 66%, which was lower than 20. 00% in the control group(χ^(2)= 4. 797,P= 0. 029).Conclusion The effect of sufentanil combined with intravenous anesthesia in pediatric urological surgery is better, while stabilizing hemodynamic indexes, it can reduce the additional dose of anesthesia and promote faster recovery of children after surgery, it reduces adverse reactions, reduces the impact on children′s cognitive function, and relieves children′s pain, it is safe and worthy of promotion.