瑞芬太尼复合丙泊酚或七氟烷对小儿扁桃体切除术术后躁动的影响  

The influence of remifentanil combined with propofol or sevoflurane on children undergoing tonsillectomy or adenoidectomy for postoperative agitation

作　　者：陈兰凤[1] 张瑞东[1] 朱邵军 金豪杰 高宝斌[1] 刘华程[2] 

机构地区：[1]浙江省舟山市妇幼保健院麻醉科,浙江舟山316000 [2]温州医科大学附属第二医院麻醉科,浙江温州325027

出　　处：《中国现代医生》2016年第6期81-83,87,共4页China Modern Doctor

基　　金：浙江省公益研究社会发展项目(2015C33100);浙江省医药卫生科技项目(2015KYB249)

摘　　要：目的评估瑞芬太尼复合丙泊酚全凭静脉麻醉或复合七氟烷与纯七氟烷全麻分别用于小儿扁桃体、腺样体手术对术后躁动（EA）的影响。方法选择2011年7月~2012年10月间120例ASAⅠ~Ⅱ级择期行扁桃体、腺样体手术的学龄前患儿分为三组：瑞芬太尼复合丙泊酚静脉全麻组（Ⅰ组）、瑞芬太尼复合七氟烷组（Ⅱ组）和纯七氟烷吸入全麻组（Ⅲ组）,每组40例。术中根据患儿的血压心率变化调整七氟烷吸入浓度和丙泊酚泵注速度。观察患儿术后苏醒、拔管情况及术后躁动发生情况。结果Ⅰ组患儿自主呼吸恢复时间、苏醒时间、拔管时间均少于Ⅱ组和Ⅲ组[（4.03±1.38）vs（9.42±1.21）vs（10.22±1.71）min,（5.15±1.27）vs（9.68±1.58）vs（11.64±1.78）min,（5.89±1.60）vs（10.58±2.10）vs（12.18±2.30）min,P〈0.001];Ⅰ组、Ⅱ组儿童麻醉后躁动评分（PAED）≥10分的例数少于Ⅲ组（15 vs 27,P〈0.001;16 vs 27,P〈0.05）,Ⅰ组、Ⅱ组四点法EA评分≥3分的例数少于Ⅲ组（11 vs 11 vs21,P〈0.05）。结论瑞芬太尼复合丙泊酚全凭静脉或复合静吸复合七氟烷麻醉用于小儿扁桃体、腺样体手术,较单纯七氟烷吸入麻醉术后躁动的发生率低,其中瑞芬太尼复合丙泊酚全凭静脉麻醉术后苏醒更快。Objective To assess the influence of remifentanil combined with propofol or sevoflurare in general anesthesia or sevoflurane anesthesia on children undergoing tonsillectomy or adenoidectomy for postoperative agitation（EA）.Methods A total of 120 preschool children with ASAⅠ-Ⅱ requesting tonsillectomy or adenoidectomy from July 2011 to October 2012 were randomly divided into three groups： remifentanil combined with propofol intravenous anesthesia group（group Ⅰ）; remifentanil combined with sevoflurane group（group Ⅱ）; sevoflurane inhalation anesthesia group（group Ⅲ）. Adjusted the concentration of sevoflurane and the infusion speed of propofol according to the depth of anesthesia. The time of resuscitation, the time of extubation and the incidence of EA were recorded. Results The time of spontaneous breathing recover and the time of resuscitation and the time of extubation in group Ⅰ were less than group Ⅱand Ⅲ[（4.03±1.38） vs（9.42±1.21） vs（10.22±1.71） min（5.15±1.27） vs（9.68±1.58） vs（11.64±1.78） min,（5.89±1.60） vs（10.58±2.10） vs（12.18±2.30） min, P0.01];The case of PAED ≥10 in groupⅠand Ⅱwas less than in group Ⅲ（15 vs 27,P0.01;16 vs 27,P〈0.05）,and the case of EA ≥3 in groupⅠand Ⅱ was less than in group Ⅲ（11 vs 11 vs 21,P〈0.05）. Conclusion Remifentanil combined with propofol or sevoflurane used in pediatric tonsillectomy or adenoidectomy has little influence on EA compared with sevoflurane inhalation anesthesia,Remifentanil combined with propofol in total intravenous anesthesia was profit for wakeing up more fast.

关 键 词：瑞芬太尼 七氟烷 丙泊酚 扁桃体腺样体手术 术后躁动 

分 类 号：R726.1[医药卫生—儿科]