地氟烷和七氟烷在小儿日间手术中的应用效果比较

Comparison of Application Effect of Desflurane and Sevoflurane during Daytime Surgery in Pediatric

目的:比较地氟烷与七氟烷在小儿日间手术中的应用效果,探讨分析两种吸入麻醉药物的优缺点,进而为小儿日间手术安全应用麻醉药物提供更好的方案。方法:选取2020年6月-2021年6月锦州医科大学附属第一医院小儿日间手术62例,随机分为七氟烷组(SEV组)和地氟烷组(DES组),每组31例。比较两组麻醉诱导前(T_(1))、置入喉罩后(T_(2))、手术开始时(T_(3))、拔出喉罩时(T_(4))的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2));比较两组出现体动反应时间、拔出喉罩时间、小儿麻醉苏醒期谵妄(PAED)评分、儿童和婴儿术后疼痛(CHIPPS)评分、恢复室停留时间及不良反应发生情况。结果:两组在T_(1)、T_(2)、T_(3)、T_(4)时刻的MAP、HR、SpO_(2)比较,差异均无统计学意义(P>0.05)。DES组出现体动反应时间、拔出喉罩时间、恢复室停留时间均短于SEV组,差异均有统计学意义(P<0.01)。DES组与SEV组在入恢复室即刻、入恢复室5 min时的PAED评分比较,差异均有统计学意义(P<0.05);入恢复室10 min时,两组PAED评分比较,差异无统计学意义(P>0.05)。DES组与SEV组在入恢复室即刻的CHIPPS评分比较,差异有统计学意义(P<0.05);在入恢复室5、10 min时,两组CHIPPS评分比较,差异均无统计学意义(P>0.05)。DES组术后口腔分泌物增多、术后躁动及恶心呕吐的发生率均低于SEV组,差异均有统计学意义(P<0.05)。结论:地氟烷和七氟烷均可安全应用于小儿日间手术。但与七氟烷相比,地氟烷在苏醒速度、苏醒质量方面更具有优势,麻醉恢复室停留时间更短,且术后不良反应的发生率更低。

Objective:To compare the application effects of Desflurane and Sevoflurane in pediatric daytime surgery,and to explore and analyze the advantages and disadvantages of the two inhaled anesthetics,so as to provide a better scheme for the safe application of anesthetics in pediatric daytime surgery.Method:A total of 62 cases of pediatric daytime surgery in the First Affiliated Hospital of Jinzhou Medical University from June 2020 to June 2021 were selected.They were randomly divided into Sevoflurane group(SEV group)and Desflurane group(DES group),with 31 cases in each group.Mean arterial pressure(MAP),heart rate(HR)and pulse oxyge saturation(SpO_(2))before anesthesia induction(T_(1)),after laryngeal mask placement(T_(2)),at the beginning of operation(T_(3))and when the laryngeal mask was removed(T_(4))were compared between the two groups;the time of body movement reaction,the time of pulling out the laryngeal mask,paediatric anesthesia emergence delirium(PAED)score,children and infants postoperative pain scale(CHIPPS)score,recovery room stay time and adverse reactions were compared between the two groups.Result:There were no significant differences in MAP,HR and SpO_(2) between the two groups at T_(1),T_(2),T_(3) and T_(4)(P>0.05).The time of body movement reaction,the time of pulling out the laryngeal mask and the residence time of recovery room in the DES group were significantly shorter than those in the SEV group(P<0.01).There were significant differences in PAED scores between DES group and SEV group immediately after entering the recovery room and 5 min after entering the recovery room(P<0.05);there was no significant difference in PAED score between the two groups 10 min after entering the recovery room(P>0.05).There was significant difference in CHIPPS score between DES group and SEV group immediately after entering the recovery room(P<0.05);and there were no significant differences in CHIPPS scores between the two groups at 5 and 10 min after entering the recovery room(P>0.05).The incidence of increased oral secretions,postoperative restlessness,nausea and vomiting in the DES group were lower than those in the SEV group,the differences were statistically significant(P<0.05).Conclusion:Both Desflurane and Sevoflurane can be safely used in pediatric daytime surgery.However,compared with the Sevoflurane,the Desflurane has more advantages in recovery speed and quality,shorter stay in the anesthetic recovery room,and the incidence of postoperative adverse reactions are lower.