瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性观察  

Observation on the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia in interventional procedures for children with congenital heart disease

作　　者：刘新燕[1] 董丽蕴 陈永学[1] 王新波[1] 孙颜 吕航宇[1] LIU Xin-yan;DONG Li-yun;CHEN Yong-xue;WANG Xin-bo;SUN Yan;LYU Hang-yu(Department of Anesthesiology, Handan Central Hospital, Hebei Province, Handan 056000, China)

机构地区：[1]河北省邯郸市中心医院麻醉科,河北邯郸056000

出　　处：《河北医科大学学报》2022年第2期208-212,228,共6页Journal of Hebei Medical University

基　　金：河北省科技计划项目(162777196)。

摘　　要：目的探讨瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性。方法选取本院行先天性心脏病介入术治疗的患儿120例,随机分为丙泊酚复合瑞芬太尼(propofol and remifentanil,PR)组与丙泊酚复合七氟醚(propofol and sevoflurane,PS)组,均60例。PR组麻醉诱导:瑞芬太尼4.0μg/L、丙泊酚4.0 mg/L。麻醉维持:丙泊酚2.5~4.0 mg/L、瑞芬太尼4.0μg/L,调节丙泊酚浓度使听觉诱发电位指数维持在25~30。PS组麻醉诱导:丙泊酚2 mg/kg及经喉罩七氟醚吸入,浓度由2%开始增大(最大浓度7%)。麻醉维持:丙泊酚6 mg·kg^(-1)·h^(-1),七氟醚1%~3%。比较2组诱导前(T0)、置喉罩时(T1)、置入喉罩后3 min(T2)、手术结束(T3)及拔除喉罩(T4)的心率、呼吸频率、平均动脉压、血氧饱和度、颈静脉球血氧饱和度(jugular bulb venousoxygen saturation,S-jvO_(2))及脑动静脉血氧含量差(cerebral arterial venous oxygen content difference,Da-jvO_(2))、拔管时间、苏醒时间、麻醉恢复室停留时间、术后住院时间、并发症发生率。结果①随着时间的变化,2组心率、呼吸频率、平均动脉压均呈先降低、后升高的变化趋势,组间比较、时点间比较以及组间和时间点的交互作用的差异均有统计学意义(P<0.05)。②随着时间的变化,2组S-jvO_(2)、Da-jvO_(2)均呈先降低后升高的变化趋势,组间比较、时间点比较以及分组和时间点的交互作用差异均有统计学意义(P<0.05)。③2组麻醉恢复室停留时间、术后住院时间的差异无统计学意义(P>0.05),PS组拔管时间短于PR组(P<0.05)。④2组并发症总发生率分别为13.33%和10.00%,差异无统计学意义(P>0.05)。结论丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的术中生命体征较瑞芬太尼联合丙泊酚靶控输注更为平稳,且更有利于脑氧供需平衡。Objective To explore the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia for interventional treatment of congenital heart disease(CHD)in children.Methods A total of 120 children who underwent interventional treatment for CHD in our hospital were selected and randomly divided into the propofol and remifentanil(PR)group(n=60)and the propofol and sevoflurane(PS)group(n=60).Anesthesia induction was performed in the PR group with remifentanil(4.0μg/L)and propofol(4.0 mg/L).Anesthesia was maintained with propofol(2.5~4.0 mg/L)and remifentanil(4.0μg/L).The concentration of propofol was adjusted to maintain A-line ARX index at 25~30.Anesthesia induction was performed in the PS group using propofol(2 mg/kg)and sevoflurane inhalation throμgh a laryngeal mask,and the concentration was increased from 2%(maximum concentration 7%).Anesthesia maintenance was kept using propofol(6 mg·kg^(-1)·h^(-1))and sevoflurane(1%to 3%).The heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2)),jugular bulb venousoxygen saturation(S-jvO_(2))and cerebral arterial venous oxygen content difference(Da-jvO_(2))before induction(T0),at laryngeal mask insertion(T1),at 3 min after laryngeal mask insertion(T2),immediately after operation(T3),and at laryngeal mask removal(T4),as well as extubation time,recovery time,residence time in anesthesia recovery room,postoperative hospital stay,complication and rate were compared between the two groups.Results①With the change of time,HR,RR,and MAP of the two groups initially decreased and then increased.The differences between groups,time points and interactions between groups and time points were statistically significant(P<0.05).②With the change of time,S-jvO_(2) and Da-jvO_(2) in the two groups initially decreased and then increased.The differences between the groups,the time points,and the interaction between groups and time points were all statist

关 键 词：心脏病 丙泊酚 七氟醚 

分 类 号：R541[医药卫生—心血管疾病]