小儿扁桃体腺样体切除术中异丙酚、瑞芬太尼的麻醉效果观察  

EFFECTS OF PROPOFOL/REMIFENTAINIL ANESTHESIA IN CHILDREN UNDERGOING ADENOTONDILLECTOMY

作　　者：解雅英[1] 吴洁[1] 吴莉[1] 于建设[1] 

机构地区：[1]内蒙古医学院附属医院麻醉科,内蒙古呼和浩特010050

出　　处：《内蒙古医学院学报》2009年第6期567-570,共4页Acta Academiae Medicinae Neimongol

基　　金：国家自然科学基金(30860327)

摘　　要：目的：比较异丙酚、瑞芬太尼与氯胺酮、芬太尼在小儿扁桃体摘除术中对血压、心率变化和术后恢复的影响。方珐：择期行扁桃体腺样体切除术的患儿4JD例，随机分为两组（R和F组）。R组基础麻醉静注异丙酚O．5～1m∥妇，诱导：瑞芬太尼2ug／kg，维库溴铵0．1mg／k，异丙酚1～2mg／kg经口气管插管行机械通气，维持PetCO235～45mmHg；麻醉维持：静脉泵注瑞芬太尼10-20ug／kg／h，异丙酚5～10mg／kg／h。F组基础麻醉肌注氯胺酮5mg／kg，诱导：芬太尼2ug／k，余同R组。观察入室后（T0）、诱导后（T1）、插管后（T2）、手术开始时（T3）、术毕（T4）、拔管时（L）血压心率变化及停药至拔管时间，苏醒时间。结果：R组入室后心率、血压较F组高，两组均未有呼吸抑制。诱导后R组心率较F组降低明显（P〈0．01），插管后R组心率、血压较F组低（P〈0．05），其余各时点血压、心率变化差异无统计学意义。停止麻醉药至患儿呼吸恢复时间，拔管时间，意识恢复耐间R组早于F组（P〈0．01）。结论：异丙酚、瑞芬太尼较氯胺酮、芬太尼在小儿扁桃体摘除术中麻醉平稳，麻醉深度可控性强。术后呼吸、意识恢复迅速完善。Objective：To compare the effects of propofol/remifentainil anesthesia with ketamine/ fentainyl in children undergoing adenotondillectomy. Methods： Forty children with ASA Ⅰ or Ⅱ, scheduled for elective adenotondillectomy, who were randomly derided into two groups （n = 20 ） , Pa- tients were predemicated with intravenous propofol 0.5 -1 mg/kg in group R. Patients were predemicated with intramuscular ketamine 5 - 6 mg/kg before the entrance to the operating room respectively in grorp F. Patients were induced with 21ug/kg remifentainil, 1 - 2mg/kg propofol and 0. lmg/kg vecuronium in group R. The patients were mechanically ventilated after tracheal intubation, maintained PetCO2 at 35- 45mmHg during operation. Anesthesia was maintained by means of continous infusion 10 - 20ug/kg/h remifentainil, 5 - 10mg/kg/h propofol. BP and HR were recorded after entrance （ T0 ）, after induction （ T1）, tracheal intubation instantly （T2）, at begin of operation （ T3 ）, at end of operation（ T4 ） and extubation（ T5 ）. Breathing recovery, extubation and consciousness recovery time were recorded. Results：HR and BP were higher significantly after intrance in group R than in group F. The breathing inhibition hasnt been found in two groups. HR decreases significantly after induetion in group R than in group F （P 〈0.01 ）. HR and BP were lower significantly after intabation in group R than in group F（ P 〈 0.05 ）. The change of HR and BP havent difference significantly between two groups in othertime. The time of breathing recovery, extubation and eonseousness recovery were shorer sinficantly in group R than in group F （P 〈 0.01 ）. Condusion： The stability and eontrolliability of propofol/remifentanil anesthesia are exeellenter and recovery is faster than ketamine/fentanyl anesthesia in children undergoing adenotondillectomy.

关 键 词：异丙酚 瑞芬太尼 氯胺酮 芬太尼 儿童 

分 类 号：R614.2[医药卫生—麻醉学]