芬太尼与瑞芬太尼用于小儿气管异物取出术的对比研究  

Comparison of Fentanyl and Remifentanil in children underwent airway foreign body removal

作　　者：陈玲玲[1] 周力 费建[1] 王建设[1] 张锡凤[1] 王俊林[1] Ling-ling Chen;Li Zhou;Jian Fei;Jian-she Wang;Xi-feng Zhang;Jun-lin Wang(Department of Anesthesiology, Children’s Hospital of Nanjing Medical University,Nanjing, Jiangsu 210008, China)

机构地区：[1]南京医科大学附属儿童医院麻醉科,江苏南京210008

出　　处：《中国内镜杂志》2017年第12期41-45,共5页China Journal of Endoscopy

摘　　要：目的比较丙泊酚复合芬太尼或瑞芬太尼的全静脉麻醉用于小儿气管异物取出术的安全性和有效性。方法选择280例择期行气管异物取出术的患儿,年龄1~3岁,随机分为两组:芬太尼组(F组,n=140),给予丙泊酚2.00~3.00 mg/kg、芬太尼2.00μg/kg行麻醉诱导,丙泊酚200.00~500.00μg/(kg·min)泵注维持麻醉;瑞芬太尼组(R组,n=140),给予丙泊酚2.00~3.00 mg/kg、瑞芬太尼1.00~1.50μg/kg行麻醉诱导,丙泊酚200.00~500.00μg/(kg·min)、瑞芬太尼0.10~0.20μg/(kg·min)维持麻醉。两组患儿均保留自主呼吸。观察置镜前(T_1)、置镜后1 min(T_2)、3 min(T_3)、退镜后3 min(T_4)、10 min(T_5)的脉搏氧饱和度(Sp O_2)及退镜后(T_6)的呼气末二氧化碳分压(P_(ET)CO_2),记录置镜过程中体动、呛咳、屏气、低氧血症的发生情况以及诱导时间、手术时间、苏醒时间和静脉药物用量。结果两组的Sp O_2在各时点均在正常范围,但R组Sp O_2在T_(2~5)明显高于F组(P<0.05)。T_6时R组P_(ET)CO_2低于F组(P<0.05)。R组置镜过程中体动、呛咳的发生率与F组相比差异无统计学意义(P>0.05),而屏气、低氧血症发生率均低于F组(P<0.05)。R组诱导和苏醒时间均明显低于F组(P<0.05),手术时间和丙泊酚用量两组比较差异无统计学意义(P>0.05),芬太尼用量明显多于瑞芬太尼(P<0.05)。结论丙泊酚复合芬太尼或瑞芬太尼在气管异物取出术中安全有效,但丙泊酚复合瑞芬太尼可提供更稳定的氧合、诱导苏醒更快及减少术中不良反应的发生。Objective To compare the safety and effectiveness of Propofol-Fentanyl and Propofol-Remifentanil total intravenous anesthesia for airway foreign body(FB)removal in children.Method280children aged1~3years underwent rigid bronchoscopy for FB removal were randomized into two groups.The Fentanyl group(Group F,n=140)were given Propofol2.00~3.00mg/kg and Fentanyl2.00μg/kg for induction and Propofol200.00~500.00μg/(kg·min)for maintenance of anesthesia.The Remifentanil group(Group R,n=140)were given Propofol2.00~3.00mg/kg and Remifentanil1.00~1.50μg/kg for induction of anesthesia,while anesthesia was maintained with Propofol200.00~500.00μg/(kg·min)and Remifentanil0.10~0.20μg/(kg·min).All the children during the procedure were with spontaneous respiration.SpO2before inserting rigid bronchoscope(T1),1min(T2)and3min(T3)after insertion,3min(T4)and10min(T5)after extraction were recorded.PETCO2after endoscopy(T6)was measured.Adverse events,including body movement,cough,breath-holding,and hypoxemia,were observed.The time of induction,surgery,recovery and the total dosage of the intravenous agents were recorded.Results SpO2of the two groups were in normal range at T1～5,which was higher in group R than group F at T2～5(P<0.05).PETCO2of group R was lower than group F at T6(P<0.05).The rate of body movement and cough were comparable between the two groups(P>0.05),while breath-holding and hypoxemia were more frequent in group F(P<0.05).The time of induction and recovery were shorter in group R(P<0.05),while surgery time and the Propofol dosage were similar(P>0.05).The total dose of Fentanyl was significantly higher than Remifentanil(P<0.05).Conclusion Combination of Propofol with Fentanyl or Remifentanil both produce effective anesthesia in children undergoing FB removal.But Propofol-Remifentanil provides more stable oxygen saturation,faster induction and recurrence of anesthesia,as well as less intraoperative complications.

关 键 词：瑞芬太尼 全静脉麻醉 自主呼吸 气管异物 

分 类 号：R614.2[医药卫生—麻醉学]