靶控输注异丙酚及静脉输注瑞芬太尼用于小儿麻醉与静吸复合麻醉的比较  

Intravenous anesthesia with target-controlled infusion of propofol and intravenous infusion of remifentanil in pediatric patients: comparison with combined isoflurane inhalation and propofol infusion anesthesia

作　　者：张月英[1] 赵林林[1] 

机构地区：[1]徐州医学院附属医院麻醉科,江苏徐州221002

出　　处：《徐州医学院学报》2005年第4期296-299,共4页Acta Academiae Medicinae Xuzhou

摘　　要：目的比较靶控输注(TCI)异丙酚、静脉输注瑞芬太尼用于小儿麻醉与静吸复合麻醉对血流动力学的影响及苏醒期特点。方法选择40例行扁桃体或增殖体切除术的患儿,年龄4～12岁,ASAⅠ～Ⅱ级,随机分为全静脉麻醉(TIVA)组和静吸复合麻醉(C)组,每组20例。常规麻醉诱导后,TIVA组采用靶控输注异丙酚、静脉输注瑞芬太尼维持麻醉,C组采用吸入异氟醚及静脉输注异丙酚维持麻醉。手术结束后立即停止所有药物的输入。记录术中的血压(BP)、心率(HR)、脉搏氧饱和度(SpO2)和术毕停药后自主呼吸恢复时间、呼之睁眼时间、拔管时间;观察患儿拔管后即刻、1h、3h的意识状态(OAAS评分)以及术后躁动和恶心呕吐的发生率。结果C组术中的HR较TIVA组明显增快,并且苏醒期躁动的发生率也较TIVA组高。2组术后自主呼吸恢复时间、睁眼时间、拔管时间差异无显著性,但TIVA组拔管后即刻、1h的OAAS评分高于C组。结论靶控输入异丙酚、静脉输注瑞芬太尼用于小儿是一种较好的麻醉方法,与静吸复合麻醉比较术中的HR较低、苏醒质量较优良。Objective To compare a propofol- remifentanil anesthesia with an isoflurane anesthesia with regard to the intraoperative hemodynamics and recovery characteristics in children. Methods Forty children （aged 4 - 12 years, ASA Ⅰ - Ⅱ ） scheduled for adenotonsillectomy were randomly assigned to receive total intravenous anesthesia （TIVA group, n = 20） and combined isoflurane anesthesia（ C group, n = 20）. After standard i.v. induction of anesthesia in both groups, TIVA was maintained with target - controlled infusion of propofol and intravenous remifentanil, while C anesthesia was maintained with isoflurane and intravenous propofol. At the end of surgery, the anesthetics were terminated. SBP, DBP, HR, SpO2 and ECG were monitored during anesthesia. The recovery of spontaneous breathing, time of extubation, time of＇eye opening, OAA/S scores, incidence of agitation and incidence of nausea and vomiting, were noted after operation. Results Both anesthesia methods resulted in stable hemodynamics, but in C group, the HR was significantly higher and there was a higher incidence of agitation. The interval between the termination of anesthetics and the full recovery of spontaneous breathing, eye opening and tracheal extubation, did not differ significantly in the two groups. The OAA/S scores at extubation and 1 h later were significantly higher in TIVA group than in C group. Conclusion In children, TIVA with remifentanil and TCI propofol is well tolerated, causing a lower peroperative heart rate and resulting in a better recovery than isoflurane anesthesia.

关 键 词：异丙酚 药物投与系统 血流动力学 麻醉 静脉内 麻醉 吸入 小儿 

分 类 号：R614.2[医药卫生—麻醉学]