先天性上睑下垂患儿不同全麻术中体温升高的发生

Development of elevated body temperature during surgery under different general anesthesias in pediatric patients with congenital ptosis

目的对先天性上睑下垂患儿,观察不同全麻下双侧眼睑矫正术中体温升高的发生情况。方法择期双侧眼睑矫正术的上睑下垂患儿60例,性别不限,年龄2~10岁,ASA分级Ⅰ级,采用随机数字表法分为全凭静脉麻醉组(TIVA组)和静吸复合麻醉组(CIIA组),每组30例。麻醉诱导:两组均依次静脉注射丙泊酚1~2 mg/kg、顺阿曲库铵0.15~0.25 mg/kg、芬太尼2~3μg/kg,行气管插管术。麻醉维持:TIVA组静脉泵注丙泊酚50~200μg·kg^(-1)·min^(-1)、瑞芬太尼0.2~0.5μg·kg^(-1)·min^(-1);CIIA组静脉泵注丙泊酚25~75μg·kg^(-1)·min^(-1)、瑞芬太尼0.2~0.5μg·kg^(-1)·min^(-1)复合吸入1%~1.5%七氟烷。麻醉诱导完成后持续监测患儿鼻咽温至手术结束,记录术中体温升高(≥37.5℃)发生情况。结果TIVA组和CIIA组体温升高发生率分别为20%和40%;两组患儿均未见体温≥39.0℃;两组体温升高发生率及体温升高程度构成比比较差异均无统计学意义(P>0.05)。结论本研究采用的全凭静脉麻醉和静吸复合麻醉方法,用于先天性上睑下垂患儿双侧眼睑矫正术时,虽然并发轻度体温升高均为非小概率事件,但从恶性高热并发症发生评估是安全的。

Objective To observe the development of elevated body temperature during surgical correction under different general anesthesias in the pediatric patients with congenital ptosis.Methods Sixty American Society of Anesthesiologists Physical Status classificationⅠpediatric patients with blepharoptosis of both sexes,aged 2-10 yr,undergoing elective surgery for blepharoptosis correction,were divided into total intravenous anesthesia group(TIVA group)and combined intravenous-inhalational anesthesia group(CIIA group)using a random number table method,with 30 cases in each group.Anesthesia was induced with intravenous propofol 1-2 mg/kg,cisatracurium 0.15-0.25 mg/kg and fentanyl 2-3μg/kg in both groups,and then the patients were endotracheally intubated.Anesthesia was maintained with intravenous infusion of propofol 50-200μg·kg^(-1)·min^(-1)and remifentanil 0.2-0.05μg·kg^(-1)·min^(-1)in TIVA group and with intravenous infusion of propofol 25-75μg·kg^(-1)·min^(-1)and remifentanil 0.2-0.5μg·kg^(-1)·min^(-1)and inhalation of 1%-1.5%sevoflurane in CIIA group.After completion of anesthesia induction,the nasopharyngeal temperature was continuously monitored until the end of surgery,and the occurrence of elevation in intraoperative body temperature(≥37.5℃)was recorded.Results The incidence of elevated body temperature was 20%and 40%in TIVA group and CIIA group,respectively.Body temperature≥39.0℃did not occur in two groups.There was no significant difference in the incidence of elevated body temperature and constituent ratio of degree of elevation in body temperature between the two groups(P>0.05).Conclusions When total intravenous anesthesia and combined intravenous-inhalational anesthesia are used in the surgery for blepharoptosis correction in the pediatric patients with congenital ptosis,concurrent mild hypothermia is a non-small probability event,but it is safe to evaluate it in terms of the occurrence of malignant hyperthermia.