瑞芬太尼、丙泊酚复合七氟醚在小儿腹股沟斜疝腹腔镜手术中的麻醉效果

Anesthetic effect of remifentanil and propofol combined with sevoflurane in laparoscopic inguinal hernia surgery in children

目的探讨瑞芬太尼与丙泊酚分别复合七氟醚在小儿腹股沟斜疝腹腔镜手术中的麻醉效果。方法选取2020年6月至2021年6月在宣城市中心医院进行腹腔镜腹股沟斜疝择期手术的患儿60例作为研究对象。将所有患儿按随机数字表法分为2组,瑞芬太尼组采用瑞芬太尼联合七氟醚麻醉(30例);丙泊酚组患者采用丙泊酚联合七氟醚麻醉(30例)。记录2组患儿术毕拔管时间、苏醒时间、定向恢复时间,麻醉前(T_(0))、诱导后(T_(1))、气腹5 min(T_(2))、拔管后(T_(3))各时间段内的平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))等应激指标,术后儿童麻醉苏醒期躁动评分量表(PAED)和儿童疼痛行为量表(FLACC),以及患儿术后不良反应发生情况。结果瑞芬太尼组患儿拔管时间、苏醒时间、定向恢复时间均小于丙泊酚组(P<0.05);与T_(0)相比,2组患儿T_(2)、T_(3)的MAP、心率、SpO_(2)均逐渐降低(P<0.05)。在相同阶段对比中,瑞芬太尼组T_(1)、T_(2)、T_(3)的MAP、心率波动均小于丙泊酚组(P<0.05),SpO_(2)高于丙泊酚组(P<0.05);瑞芬太尼组术后PAED评分低于丙泊酚组(P<0.05);苏醒6 h(t2)、苏醒12 h(t3)时刻较苏醒时(t0)时刻2组疼痛评分均明显降低(P<0.05);且瑞芬太尼组t0~t3的FLACC评分均低于丙泊酚组(P<0.05);瑞芬太尼组总不良反应低于丙泊酚组(P<0.05)。结论七氟醚联合瑞芬太尼在小儿股沟斜疝腹腔镜术中麻醉效果和血流动力学优于丙泊酚组,缩短患儿术后苏醒时间,有效缓解患儿术后疼痛和躁动程度,减轻对患儿呼吸抑制等不良反应的影响。

Objective To investigate the anesthetic effects of remifentanil and propofol combined with sevoflurane in laparoscopic inguinal hernia surgery in children.Methods A total of 60 cases of children undergoing laparoscopic oblique surgery of the groin and thigh in our hospital from June 2020 to June 2021 were selected as the research objects.All the children were randomly divided into two groups according to the number method,remifentanil combined with sevoflurane for the remifentanil group(30 cases)and propofol combined with sevoflurane in propofol group(30 cases).The extubation time,recovery time,directional recovery time,mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_(2))and other stress indicators were recorded in the two groups before anesthesia(T_(0)),after induction(T_(1)),pneumoperitoneum 5 min(T_(2)),and after extubation(T_(3)).Postoperative agitation score(PAED)and pain score(FLACC),and the incidence of postoperative adverse reactions were also recorded.Results The extubation time,awakening time and directional recovery time in the remifentanil group were shorter than those in the propofol group(P<0.05).Compared with T_(0),MAP,HR and SpO_(2) of T_(2) and T_(3) in the two children's groups were gradually decreased(P<0.05).At the same stage,MAP and HR fluctuations of T_(1),T_(2) and T_(3) in the remifentanil group were lower than those in the propofol group(P<0.05),and SpO_(2) was higher than that in the propofol group (P<0.05). The PAED score of the remifentanil group was lower than that of the propofol group (P<0.05). The pain scores of the two groups were significantly lower at 6 h (t2) and 12 h (t3) than at t0 (P<0.05). The FLACC score of t0-t3 in the remifentanil group was lower than that in the propofol group (P<0.05). The total adverse reactions in the remifentanil group were lower than those in the propofol group (P<0.05). Conclusion In laparoscopic indirect femoral sulcus hernia in children, the anesthetic effect and hemodynamics of sevoflurane combined with remifentanil were better than those of the propofol group. This shortened the time it took for children to recover from surgery, reduced postoperative pain and agitation, and lessened the effects of side effects like respiratory depression.