不同剂量瑞芬太尼靶控输注复合七氟醚用于小儿腭裂整复术的临床观察  

Clinical effect of target-controlled intravenous administration of remifentanyl at different target concentrations combined with inhalation of sevoflurane in pediatric palatorrhaphy surgery

作　　者：雷蕾 康伟 李正强 陈文平 罗秋英 张锡逵 LEI Lei;KANG Wei;LI Zhengqiang;CHEN Wenping;LUO Qiuying;ZHANG Xikui(Department of Anesthesiology,Stomatological Hospital,Southern Medical University,Guangzhou 510280,China)

机构地区：[1]南方医科大学口腔医院麻醉科,广州510280

出　　处：《实用医学杂志》2018年第14期2406-2409,共4页The Journal of Practical Medicine

基　　金：广东省医学科研基金(编号:A2014114)

摘　　要：目的观察不同剂量瑞芬太尼靶控输注(TCI)复合七氟醚在小儿腭裂整复术中对血流动力学及麻醉并发症的影响,寻找瑞芬太尼的最佳靶浓度。方法 60例腭裂患儿按瑞芬太尼2、3和4 ng/m LTCI血浆浓度随机分为R2、R3和R4组,每组20例。静注咪达唑仑0.1 mg/kg、丙泊酚2.0 mg/kg、芬太尼2.0μg/kg、琥珀胆碱2.0 mg/kg经口插管。复合2%七氟醚维持麻醉。记录诱导完(T0)、TCI后5 min(T1)、分离腭瓣时(T2)、术毕(T3)、拔除气管导管时(T4)、拔管后15 min(T5)6个时点血流动力学数据;苏醒期各种时间指标及术中术后不良反应发生情况。结果 HR值在T1、T2、T3时点R2、R3、R4组均依次明显降低,R4组比R2组降低更明显;MAP值在T1、T2、T3时点R4组均明显低于R2、R3组。术中出血量R3、R4组明显少于R2组,自主呼吸恢复时间R2组明显短于R4组;术后睁眼时间R2、R3组明显短于R4组;拔管时间及麻醉苏醒时间R2组明显短于R3、R4组。R4组心动过缓明显高于R2、R3组、呛咳明显低于R2、R3组;苏醒即刻躁动R2、R3、R4组依次明显减轻(P<0.05)。结论 3 ng/m L瑞芬太尼TCI复合2%七氟醚可为小儿腭裂整复术提供最佳麻醉效果。Objective To investigate the clinical effect of remifentanil at different target concentrations by target-controlled-infusion(TCI)combined with inhalation of sevolfurane during pediatric palatorrhaphy surgery.Methods According to target concentrations of remifentanil of 2,3 and 4 ng/mL,60 children with cleft palate were randomly divided into R2,R3 and R4 group,with 20 cases in each group.After intravenous induction,intubation and mechanical breathing were performed,and the anesthesia was maintained by TCI remifentanil combined with inhalation of 2%sevoflurane.The data of hemodynamics were recorded at diffrent time points:after induction(T0),5 minutes after remifentanil TCI(T1),at the moment of separating palatal flap(T2),at the end of the surgery(T3),at the time of extubation(T4),and 15 min after extubation(T5).Various time indexes in the awakening period and adverse complications during and after operation were recorded.Results The HR values were successively decreased in R2,R3 and R4 at the moment of T1,T2 and T3,especially between R2 and R4.Compared with R2 and R3,the mean arterial pressure of R4 at T1,T2 and T3 significantly decreased.The intraoperative blood loss at R3 and R4 was significantly less than R2.The recovery time of spontaneous breathing in group R2 was significantly shorter than in group R4.The time of eye-opening after operation at R2 and R3 was significantly shorter than at R4.The time of extubation and the time of awakening from anesthesia at R2 were significantly shorter than at R3 and R4(P<0.05).Conclusion 3 ng/mL remifentanil by TCI combined with 2%sevoflurane could be used to provide the best anesthetic effect in pediatric palatorrhaphy surgery.

关 键 词：瑞芬太尼 靶控输注 腭裂整复术 小儿 

分 类 号：R782.054[医药卫生—口腔医学]