瑞芬太尼复合丙泊酚麻醉在婴儿唇裂修复术中的应用  

Intravenous anesthesia with Remifentanil and Propofol in infants undergoing surgical repair of cleft lip

作　　者：周长青[1] 张丽[1] 王雪芹[1] 杜洪玫[1] 

机构地区：[1]山东大学齐鲁医院第二麻醉科,济南250012

出　　处：《山东大学学报（医学版）》2008年第10期988-990,共3页Journal of Shandong University:Health Sciences

摘　　要：目的观察瑞芬太尼复合丙泊酚全麻在婴儿唇裂修复术中的临床效果。方法60例3-9个月择期行唇裂修复术婴儿，随机分为瑞芬太尼-丙泊酚组（R-P组，n=30）和羟丁酸钠-氯胺酮组（γ-K组，n=30）。麻醉诱导时，R-P组给予瑞芬太尼1μg／kg，丙泊酚2mg／kg，氯化琥珀胆碱1mg／kg；γ-K组给予羟丁酸钠80mg／kg／，氯胺酮1—2mg／kg，氯化琥珀胆碱1mg／kg。两组患儿均麻醉诱导后气管插管，保留自主呼吸。R-P组持续输注瑞芬太尼0．05～0．1μg／（kg·min）、丙泊酚4～6mg／（kg·h），7-K组间断注射氯胺酮1—2mg／kg，必要时追加羟丁酸钠，维持麻醉深度。记录术中呼吸、平均动脉压、心率变化，术后苏醒情况及并发症。结果R-P组诱导后及术中平均动脉压、心率显著低于γ-K组（P〈0．05），术后拔管、出室均比γ-K组快（P〈0．05），不良反应的发生率也显著少于γ-K组（P〈0．05）。结论瑞芬太尼复合丙泊酚用于婴儿全麻下唇裂修复术可使患儿血压、心率维持在稳定的低水平状态，术后苏醒快而完全，不良反应发生率低，是安全可行的。Objective To evaluate the efficacy and safety of intravenous anesthesia with remifentanil and propofol in infants undergoing surgical repair of cleft lip. Methods In total, 60 infants 3 to 9 month-old were enrolled and randomly received either a combination of remifentanil and propofol （R-P group, n = 30）or a combination of sodium hydroxybutyrate and ketamine（ γ-K group, n = 30）. Anesthesia was induced with remifentanil 1 μg/kg, propofol 2 mg/kg and succinytcholine chloride 1 mg/kg or sodium hydroxybutyrate 80 mg/kg,ketamine 1-2 mg/kg and succinylcholine chloride 1 mg/kg. Tracheal intubations were given after anesthesia induction and spontaneous respirations were retained. Anesthesia was maintained with remifentanil 0.05-0.1μg·kg^-1·min^-1 and propofol 4-6 μg·kg^-1·h^-1 or ketamine 1-2 mg/kg and sodium hydroxybutyrate. Respiratory rate, mean arterial blood pressure and heart rate changes were recorded at fixed intervals, also recovery characteristics and postoperative complications of the two groups were determined. Results Remifentanil in combination with propofol resulted in a lower mean arterial blood pressure, heart rate and recovery time and less post-operative side effects than sodium hydroxybutyrate in combination with ketamine. Conclusion The combination of remifentanil and propofol is safe and effective with stable hemodynamics, rapid recovery and absence of side effects in infants undergoing surgical repair of cleft lip.

关 键 词：芬太尼 丙泊酚 婴儿 麻醉 静脉 

分 类 号：R164.2[医药卫生—公共卫生与预防医学]