两种全麻方式用于小儿腭裂整复术的比较  

A comparison of two general anesthesia techniques in children undergoing cleft palate repair

作　　者：叶念[1] 徐莉[2] 

机构地区：[1]泸州医学院附属医院麻醉科,四川泸州646000 [2]成都市儿童医院麻醉科,四川成都610017

出　　处：《四川医学》2011年第5期669-671,共3页Sichuan Medical Journal

摘　　要：目的比较七氟烷瑞芬太尼静吸复合麻醉和异丙酚瑞芬太尼全凭静脉麻醉两种麻醉方式用于小儿腭裂整复术对术中麻醉维持、苏醒及术中、术后并发症的影响。方法 60例2~6岁拟行腭裂整复术患儿随机分为两组（n=30）：异丙酚瑞芬太尼全凭静脉麻醉组（P-R组）和七氟烷瑞芬太尼静吸复合麻醉组（S-R组）,分别以异丙酚瑞芬太尼全凭静脉或七氟烷瑞芬太尼静吸复合维持麻醉。观察并比较两组患儿诱导前（T1）、插管时（T2）、手术即刻（T3）、手术15min（T4）、手术30min（T5）及清醒拔管（T6）血流动力学变化;记录手术时间、清醒及拔管时间,并观察术后呕吐、呛咳及躁动等不良反应。结果术中S-R组患儿血流动力学相对平稳,P-R组患儿血流动力学变化较大,组间差异有统计学意义（P〈0.05）;S-R组停药后患儿自主呼吸恢复时间、拔管时间和清醒时间均较P-R组时间缩短,但组间差异无统计学意义（P〉0.05）;术后躁动S-R组12例（40%）P-R组3例（10%）,组间差异有统计学意义（P〈0.01）。结论七氟烷瑞芬太尼静吸复合麻醉能安全、有效地用于小儿腭裂整复术,和异丙酚瑞芬太尼全凭静脉比较,血流动力学更平稳,但是术后躁动发生比例更高。Objective To compare the maintenance and postoperative recovery pattern of sevoflurane inhalation supplemented with remifentanil infusion and propofol-remifentanil total intravenous anesthesia in children undergoing cleft palate repair.Methods Sixty children aged 2～6 years undergoing cleft palate repair were randomly allocated to 2 groups： in group S-R,the anesthesia was maintained with sevoflurane inhalation supplemented with remifentanil;in group P-R,the anesthesia was maintained with intravenous infusion of propofol and remifentanil.The haemodynamics changes were checked at different time point.Extubation time,surgery time,consciousness recovery time and adverse events such as vomit and restlessness in the two groups were evaluated.Results The haemodynamics conditions of S-R group was more stable than P-R group in operation procedure（P0.05）.No significant difference was observed in resumed spontaneous ventilation time,extubation time and consciousness recovery time.（P0.05）.The incidence of emergence agitation was more in S-R group than that in P-R（P0.01）.Conclusion Sevoflurane inhalation supplemented with remifentanil infusion anesthesia provides better stabilization,higher emergence agitation than propofol-remifentanil total intravenous anesthesia in children undergoing cleft palate repair.

关 键 词：七氟烷 瑞芬太尼 异丙酚 全身麻醉 腭裂整复术 

分 类 号：R726.1[医药卫生—儿科]