三种全麻方式用于小儿人工电子耳蜗植入术的效果比较  

作　　者：于飞[1] 陈序[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,广西530021

出　　处：《当代医学》2014年第9期9-11,共3页Contemporary Medicine

摘　　要：目的比较七氟烷吸入麻醉、丙泊酚瑞芬太尼全凭静脉麻醉及其静吸复合麻醉三种全麻方式用于小儿人工电子耳蜗植入术的诱导、维持和苏醒的效果,皆在寻找合理的用于人工电子耳蜗植入术的麻醉方法。方法拟行择期人工电子耳蜗植入术的ASA I级住院患儿120例,随机分为S组、F组和PR组(n=40)。S组患儿使用七氟烷吸入诱导及维持;F组采用丙泊酚、瑞芬太尼联合七氟烷静吸复合麻醉;PR组使用丙泊酚、瑞芬太尼全凭静脉麻醉。记录3组患儿的诱导时间、气管插管时间、拔除气管导管的时间、睁眼及意识恢复时间,苏醒后不良反应。结果 (1)F组及PR组心率在T2下降明显,与S组组间比较差异有统计学意义。F组MAP在T3下降明显,与S组组间比较差异有统计学意义。在各组内,F组HR及MAP在T2,T4与基础值T0两两比较明显降低,差异有统计学意义。(2)3组在气管插管时间、拔管时间、睁眼和意识恢复时间上差异无统计学意义。S组苏醒期躁动5例(12.5%),呕吐3例(7.5%)。3组均无呼吸抑制,喉痉挛发生。结论 3种全麻方式用于小儿人工电子耳蜗植入术均安全可行,复苏、拔管较快。七氟烷吸入麻醉组患儿术后躁动等相关并发症较易出现。全凭静脉及静吸复合麻醉无明显不良反应,在术后苏醒质量方面存在优势。相比之下,静吸复合麻醉能提供更稳定的术中血流动力学状态,有效控制麻醉深度,镇痛效果佳,减少用药量,能较好的满足显微手术术中和术后的要求。Objective To compare the general anesthetic effects of sevoflurane inhalation,propofol/remifenant combined anesthesia ,and propofol/remifenant combined sevoflurane in Pediatric cochlear implantation. Method One hundred and twenty children undergoing cochlear implantation under general anesthesia were randomly divided into three groups （40 cases for each group）：sevoflurane inhalation group（group S）, propofol-remifenant combined group （group PR）, and propofol-remifenant combined sevoflurane group （group F）. The induction time, intubation time, awaking time, extubation time and orientation time were recorded, as well as the incidence of adverse reaction after patients’waking up. Results （1） Heart rate and blood pressure fluctuation showed significant difference in T 2,T 3 among three groups. In F group, HR and MAP in T 2,T 4 were significant differences compared to T 0 （P＆lt;0.05）;（2） There was no significant difference among the three groups in the intubation time , awaking time ,extubation time and orientation time. 5 cases of agitation and 3 cases of pneumoperitoneum in group S, the incidences of adverse reaction in groups was higher than those in group F and PR. Respiratory depression, tongue falling backwards and laryngospasm did not occur in the three groups. Conclusion The three different kinds of general anesthesia are all safe and accessible in ensuring rapid recovery and extubation, but sevoflurane inhalation may cause higher incidence of agitation in the operation. Propofol-remifenant combined anesthesia and propofol-remifenant combined sevoflurane are Both have advantages in the hemodynamic stability and the quality of recovery from anesthesia. By contrast, propofol-remifenant combined sevoflurane anesthesia has better effect for analgesic and sedation, decreases the dose of drugs, also it meets the needs of the aural microsurgery.

关 键 词：全身麻醉 七氟烷 丙泊酚 瑞芬太尼 人工电子耳蜗植入术 

分 类 号：R726.1[医药卫生—儿科]