七氟烷复合瑞芬太尼麻醉在小儿短小手术中的临床观察  

Clinical Observation of Applying Sevoflurane Combined with Remifentanil Anesthesia in Mini-pediatric Surgery

作　　者：刘艳秋[1] 吴海星[1] 蒋柯[1] 胡廷菊 胡柏龙 

机构地区：[1]贵州医科大学附院麻醉科,贵州贵阳550004

出　　处：《贵阳医学院学报》2015年第6期626-629,共4页Journal of Guiyang Medical College

基　　金：贵阳市科技计划项目(筑科2014)

摘　　要：目的:探讨七氟烷复合瑞芬太尼麻醉在小儿短小手术中的应用效果。方法:将40例择期行短小手术患儿随机分为七氟烷组(S组)和七氟烷复合瑞芬太尼组(SR组),每组20例,术前均予七氟烷吸入后静脉注射咪达唑仑0.1 mg/kg、阿托品0.01 mg/kg、芬太尼3μg/kg,行气管内插管机械通气;麻醉维持,SR组采用瑞芬太尼6μg/kg·h持续静脉泵注,复合七氟烷吸入;S组仅七氟烷吸入,手术开始追加芬太尼2μg/kg,术毕拔除气管导管观察呼吸无异常送入麻醉后监测治疗室(PACU);记录两组患儿诱导前(T0),插管时(T1),插管后5 min(T2)、手术开始(T3)、手术开始后5 min(T4)、手术结束(T5)、拔除气管导管时(T6)及拔管后5 min(T7)的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(Sp O2)变化,比较两组患儿术后拔管时间、苏醒时间和拔管后呼吸道事件发生情况,对患儿进行苏醒期躁动评分(PAED)和疼痛评分(FLACC)。结果:两组患儿麻醉过程平稳,气管插管、拔管时的血流动力学变化比较,差异无统计学意义(P>0.05);拔管时间、苏醒时间SR组比S组短,差异有统计学意义(P<0.05);术后患儿PAED评分,SR组术后躁动低于S组,差异有统计学意义(P<0.05),FLACC评分比较无差异,SR组术中七氟烷用药量少于S组(P<0.05)。结论:七氟烷复合瑞芬太尼麻醉在小儿短小手术中易于维持,苏醒快,术后躁动发生率低。Objective： To investigate the effect of applying sevoflurane combined with remifentanil anesthesia in mini-pediatric surgery. Methods： Forty children were randomly divided into sevoflurane group（ S group） and sevoflurane combined with remifentanil group（ SR group） with equal number.All patients received midazolam 0. 1 mg / kg,atropine 0. 01 mg / kg,fentanyl 3 μg / kg after sevoflurane inhalation,endotracheal intubated and mechanical ventilated. For maintaining anesthesia effect,the SR group received 6 μg /（ kg·h） fentanyl continuous intravenous injection combined with sevoflurane inhalation; Group S received only sevoflurane inhalation and at the beginning of surgery received 2 μg /kg fentanyl. After surgery,the endotracheal tube was removed and the children were transferred to postanesthesia care unit（ PACU） after detecting no expiratory dyspnea. Change of HR,MAP and Sp O2 were recorded before the induction of anesthesia（ T0）,during intubation（ T1）,5 minutes after intubation（ T2）,at the beginning of surgery（ T3）,5 minutes after surgery（ T4）,the end of surgery（ T5）,removing the endotracheal tube（ T6） and 5 minutes after extubation（ T7）; comparing the extubation time,awakening time and observed the respiratory events after extubation. Pediatric Anesthesia Emergence Delirium（ PAED） scores and face,legs,activity,cry,consolability scale（ FLACC） was made.Results： The difference of endotracheal intubation and extubation hemodynamic change was not statistically significant in two groups（ P 0. 05）. The extubation and awakening time of group SR was shorter than group S,the difference was statistically significant（ P 0. 05）. The PAED scale of group SR was lower than group S,the difference was statistically significant（ P 0. 05）. No significant difference was found in FLACC between the two groups（ P 0. 05）,the dosage of sevoflurane in SR group was lower than S group（ P 0. 05）. Conclusion： Sevoflurane combined with remifentanil anesthesia

关 键 词：外科手术 小 七氟烷 瑞芬太尼 小儿 术后躁动 

分 类 号：R726.142.4[医药卫生—儿科]