七氟烷或丙泊酚复合瑞芬太尼用于小儿全身麻醉的效果比较

Effective comparison of sevoflurane and propofol combined with remifentanil for pediatric general anesthesia

目的比较两种全身麻醉方式(七氟烷复合瑞芬太尼与丙泊酚复合瑞芬太尼)在小儿全身麻醉的应用效果差异。方法选择行择期全身麻醉手术的患儿80例,随机分为A、B两组,各40例。A组采用七氟烷吸入复合瑞芬太尼靶控输注麻醉,B组采用丙泊酚复合瑞芬太尼靶控输注麻醉,A、B两组均采用经喉罩全身麻醉并在听觉诱发电位指数监测指导下进行。比较两组患儿在进入手术室诱导前(T1)、插入喉罩前(T2)、插入喉罩时(T3)、插入喉罩后(T4)、切皮时(T5)、手术15 min时(T6)、手术30 min时(T7)、手术1 h(T8)、手术结束时(T9)及出手术室时(T10)共10个时间段的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP),并比较两组患儿停止麻醉至拔除喉罩的时间及术后并发症发生率的比例差异。结果两组患儿的平均年龄、平均身高及体质量、性别差异、手术类型比例等差异无统计学意义(P>0.05)。而两组的HR、SBP、DBP、MAP在T1、T2、T3、T4、T5等5个时间点上差异无统计计学意义(P>0.05),而T6~T10等5个时间点上差异有统计学意义(均P<0.05)。A、B两组拔除喉罩时间无明显差异[(12.6±4.6)vs.(13.8±5.2)min,P>0.05],而A组术后并发症的发生率(27.50%)低于B组(50.00%),差异有统计学意义(P<0.05)。结论七氟烷复合瑞芬太尼麻醉方式较丙泊酚复合瑞芬太尼用于小儿全身麻醉具有更稳定的术中血流动力学,术后并发症的发生率更低的优势。

Objective To compare application results of two methods of general anesthesia(sevoflurane and remifentanil vs. propofol and remifentanil) in pediatric anesthesia. Methods A total of pediatric patients undergoing elective general anesthesia were randomly divided into A and B groups. Group A was given sevoflurane inhalation remifentanil TCI anesthesia; group B was given propofol combined with remifentanil TCI anesthesia fentanyl. Both groups were adopted by the laryngeal mask anesthesia and auditory evoked potential index monitoring under the guidance. Heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) of 10 periods, before entering the operating room before induction(T1), insert the laryngeal mask(T2), when you insert a laryngeal mask(T3), insert the laryngeal mask(T4), when the incision(T5), when surgery 15 min( T6), when surgery 30 min(T7), surgery 1 hour(T8), at the end of surgery(T9) and the operating room(T10),in the two groups were compared. The times to stop the anesthesia to remove the laryngeal mask and the incidence of postoperative complications in the two groups were compared. Results There were nosignificant differences in the average age, the average height and weight, gender, type of surgery proportion between the two groups of children. There were no significant differences of HR, SBP, DBP,MAP at T1, T2, T3, T4, T5 between the two groups, but they were significantly different at T6-T10. The difference of the times to stop the anesthesia to remove the laryngeal mask of the two groups wasn’t significant [(12.6±4.6) vs.(13.8±5.2)min, P<0.05]; postoperative complications in group A(27.50%) were less than those in group B(50.00%). Conclusions Compared with propofol and remifentanil anesthesia, sevoflurane and remifentanil anesthesia for children has advantages of a more stable intraoperative hemodynamics and the lower the incidence of postoperative complications.