依托咪酯复合瑞芬太尼在小儿先天性肛门闭锁手术中的麻醉效果探讨

Effect of etomidate combined with remifentanil in anesthesia for pediatric congenital anal atresia surgery

目的 探讨依托咪酯复合瑞芬太尼在小儿先天性肛门闭锁手术中的麻醉效果。方法 60例接受手术治疗的小儿先天性肛门闭锁患儿,按随机数字表法将患儿分为对照组和研究组,各30例。对照组手术中应用氯胺酮麻醉,研究组手术中应用依托咪酯复合瑞芬太尼麻醉。对比两组麻醉效果、镇静评分、疼痛评分、术中生命体征指标、术后麻醉苏醒时间、术后不良反应发生率。结果 研究组麻醉优良率100.00%比对照组的86.67%更高(P<0.05)。研究组镇静评分(3.45±0.52)分比对照组的(2.76±0.49)分高,疼痛评分(1.68±0.55)分比对照组的(2.54±0.71)分低(P<0.05)。麻醉诱导前,两组平均动脉压、心率对比均无明显差异(P>0.05);插管后、切皮后1 min,研究组平均动脉压、心率与麻醉诱导前对比均无明显差异(P>0.05),对照组平均动脉压、心率均较麻醉诱导前增高(P<0.05);研究组插管后、切皮后1 min平均动脉压和心率分别为(56.75±2.27)、(56.49±2.42)mm Hg(1 mm Hg=0.133 kPa)和(151.68±3.12)、(151.37±3.28)次/min,均比对照组的(62.98±3.09)、(59.56±2.61)mm Hg和(159.45±3.39)、(155.31±3.47)次/min低(P<0.05)。研究组术后自主呼吸恢复时间、睁眼时间、指令恢复时间分别为(7.89±2.82)、(9.04±2.45)、(16.85±3.10)min,均比对照组的(12.65±3.49)、(13.91±3.57)、(21.42±3.37)min短(P<0.05)。两组术后不良反应发生率对比无明显差异(P>0.05)。结论 在小儿先天性肛门闭锁手术中应用依托咪酯复合瑞芬太尼进行麻醉,不仅增强了患儿的手术麻醉效果,发挥了良好的镇静和镇痛作用,维持术中生命体征稳定,还缩短了患儿术后苏醒时间,兼具麻醉有效性和安全性。

Objective To explore the effect of etomidate combined with remifentanil in anesthesia for pediatric congenital anal atresia surgery.Methods A total of 60 pediatric patients with congenital anal atresia who underwent surgical treatment were randomly divided into a control group and a study group using a random number table method,with 30 cases in each group.The control group received ketamine anesthesia during surgery,while the study group received etomidate combined with remifentanil anesthesia during surgery.The anesthesia effect,sedation score,pain score,intraoperative vital sign indicators,postoperative anesthesia recovery time,and incidence of postoperative adverse reactions were compared between the two groups.Results The excellent rate of anesthesia of 100.00%in the study group was higher than 86.67%in the control group(P<0.05).The study group had higher sedation score of(3.45±0.52)points than(2.76±0.49)points in the control group,and lower pain score of(1.68±0.55)points than(2.54±0.71)points in the control group(P<0.05).Before anesthesia induction,there were no significant differences in mean arterial pressure and heart rate between the two groups(P>0.05).After intubation and 1 min after incision,the mean arterial pressure and heart rate of the study group had no significant difference compared with that before anesthesia induction(P>0.05),while the mean arterial pressure and heart rate of the control group were increased compared with that before anesthesia induction(P<0.05).After intubation and 1 min after incision,the mean arterial pressure and heart rate of the study group were(56.75±2.27),(56.49±2.42)mm Hg(1 mm Hg=0.133 kPa)and(151.68±3.12),(151.37±3.28)beats/min,which were lower than(62.98±3.09),(59.56±2.61)mm Hg and(159.45±3.39),(155.31±3.47)beats/min of the control group(P<0.05).The postoperative spontaneous breathing recovery time,eye opening time,and command recovery time of the study group were(7.89±2.82),(9.04±2.45),and(16.85±3.10)min,which were shorter than(12.65±3.49),(13.91±3.57),and(21.42±3.37)min of the control group(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion In the surgery of congenital anal atresia in children,the application of etomidate combined with remifentanil can not only enhance the surgical anesthesia effect of patients,play a good sedative and analgesic role,maintain stable intraoperative vital signs,but also shorten the postoperative recovery time,with both effective and safe anesthesia.