瑞芬太尼联合右美托咪定在腹腔镜疝囊高位结扎术中的麻醉效果及对并发症的影响

Effect of remifentanil combined with dexmedetomidine in laparoscopic high ligation of hernia sac in children and its influence on complications

目的分析瑞芬太尼联合右美托咪定在腹腔镜疝囊高位结扎手术腹股沟疝患儿的麻醉效果及对并发症的影响。方法选择2017年1月至2021年1月珠海市中西医结合医院收治的98例腹股沟疝患儿作为研究对象,研究组(49例)采用瑞芬太尼联合右美托咪定麻醉,对照组(49例)采用常规麻醉,对比入室(T_(0))、置喉罩(T1)、手术开始(T_(2))、术毕(T_(3))时段2组患儿的心率、平均动脉压(MAP)、呼气末二氧化碳分压(PETCO_(2))及脑电双频指数(BIS),记录2组患儿的拔喉罩时间、呼吸恢复时间、完全清醒时间及并发症发生情况。结果相比T_(0)时间点,T1时间点的2组患儿心率水平、MAP水平、BIS指数明显降低,研究组明显高于对照组(P<0.05),2组患儿PETCO_(2)水平较T_(0)均明显升高,但组间对比无统计学意义(P>0.05)。T_(2)时间点的2组患儿心率水平、MAP水平、BIS指数明显降低,研究组明显高于对照组(P<0.05),2组患儿的PETCO_(2)水平较T_(0)均明显升高,而研究组明显低于对照组(P<0.05)。T_(3)时间点2组患儿心率水平、BIS指数明显降低,研究组明显高于对照组(P<0.05),MAP水平低于T_(0)水平,但组间对比无差异(P>0.05);2组患儿的PETCO_(2)水平较T_(0)均明显升高,而研究组明显低于对照组(P<0.05)。研究组患儿的拔喉罩时间、呼吸恢复时间、完全清醒时间均明显低于对照组(P<0.05)。研究组患儿的呛咳及咽喉疼痛发生率稍低于对照组(P>0.05),而躁动、呼吸抑制及恶心呕吐发生率明显低于对照组(P<0.05)。结论瑞芬太尼联合右美托咪定可有效保持腹股沟疝患儿腹腔镜疝囊高位结扎术中的血流动力学稳定,具有良好的镇静及麻醉后复苏效果,并可减少围手术期并发症的发生。

Objective To analyze the effect of remifentanil combined with dexmedetomidine in laparoscopic high ligation of hernia sac in children and its effect on complications.Methods A total of 98 children with inguinal hernia who were admitted to our hospital from January 2017 to January 2021 were selected as the study subjects.The study group(49 cases)received remifentanil combined with dexmedetomidine anesthesia,and the control group(49 cases)received conventional anesthesia.The HR,MAP,PETCO_(2) and BIS were compared between the two groups at different time periods,and the time of laryngeal mask removal,respiratory recovery time,full awake time and complications were recorded between the two groups.Results Compared with the T_(0) time point,the heart rate level,MAP level and BIS index of the two groups were significantly decreased at the T_(1) time point,and the study group was significantly higher than the control group(P<0.05),while the PETCO_(2) level of the two groups was significantly higher than that of the T_(0) time point,but the comparison between the two groups was not statistically significant(P>0.05).At T_(2) time point,the heart rate,MAP level and BIS index of the two groups were significantly decreased,and the study group was significantly higher than the control group(P<0.05),while the PETCO_(2) level of the two groups was significantly higher than that of the T_(0) group,while the study group was significantly lower than the control group(P<0.05).At T_(3) time point,the heart rate and BIS index of the two groups significantly decreased,and the study group was significantly higher than the control group (P<0.05), and the MAP level was lower than the T_(0) level, but there was no difference between the two groups (P>0.05). The PETCO_(2) level of the two groups was significantly higher than that of the T_(0). The study group was significantly lower than the control group (P<0.05). The time of laryngeal mask extraction, respiratory recovery time and full awake time in the study group were significantly lower than those in the control group (P<0.05). The incidence of choking and throat pain in the study group was slightly lower than that in the control group (P>0.05), while the incidence of agitation, respiratory depression, nausea and vomiting was significantly lower than that in the control group (P<0.05). Conclusion Remifentanil combined with dexmedetomidine can effectively maintain hemodynamic stability in laparoscopic high ligation of inguinal hernia sac in children with inguinal hernia, has good sedation and post-anesthesia resuscitation effects, and reduces the incidence of perioperative complications, which is worthy of clinical promotion.