七氟烷联合丙泊酚在儿童扁桃体切除术中的麻醉效果及其对应激反应和苏醒质量的影响  

Anesthesia effect of sevoflurane combined with propofol in pediatric tonsillectomy and its impact on stress response and recovery quality

作　　者：毕星 马亚芳 杨振锋 BI Xing;MA Ya-fang;YANG Zhen-feng(Department of Anesthesiology,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市人民医院麻醉科,陕西宝鸡721000

出　　处：《海南医学》2023年第18期2678-2682,共5页Hainan Medical Journal

摘　　要：目的研究七氟烷联合丙泊酚在儿童扁桃体切除术中的麻醉效果及其对苏醒质量和应激反应的影响。方法选取2020年4月至2022年4月宝鸡市人民医院收治的90例拟行扁桃体切除术患儿为研究对象,按随机数表法分为研究组和对照组各45例。对照组患儿采用丙泊酚维持麻醉,研究组患儿采用七氟烷联合丙泊酚维持麻醉。比较两组患儿在麻醉前与拔管5 min后心率(HR)、平均动脉压(MAP)、舒张压(SBP)、收缩压(DBP)水平与应激反应[去甲肾上腺素(NE)、肾上腺素(E)、肾素(R)]水平;同时比较两组患儿拔管5 min后的苏醒质量[苏醒时间、自主呼吸恢复时间、意识恢复时间、拔管时间、苏醒期躁动(PAED)评分]与不良反应发生情况。结果麻醉前,两组患儿的HR、MAP、SBP、DBP比较差异均无统计学意义(P>0.05),而拔管5 min后,两组患儿的HR、MAP、SBP、DBP均升高,且研究组患儿的HR、MAP水平分别为(91.06±8.62)次/min、(77.18±5.86)mmHg,明显低于对照组的(98.95±9.26)次/min、(79.84±5.72)mmHg,SBP、DBP水平分别为(68.26±9.62)mmHg、(116.25±6.58)mmHg,明显高于对照组的(63.52±9.28)mmHg、(108.49±7.24)mmHg,差异均有统计学意义(P<0.05);麻醉前,两组患儿的NE、E、R水平比较差异均无统计学意义(P>0.05),而拔管5 min后,两组患儿的NE、E、R水平均升高,且研究组患儿的NE、E、R水平分别为(86.36±5.84)ng/mL、(101.32±6.58)ng/mL、(4.06±0.53)ng/mL,明显低于对照组的(118.56±6.28)ng/mL、(128.62±7.04)ng/mL、(4.95±0.76)ng/mL,差异均有统计学意义(P<0.05);两组患儿的苏醒时间、自主呼吸恢复时间、意识恢复时间、拔管时间比较差异均无统计学意义(P>0.05);研究组患儿的PAED评分为(4.58±0.64)分,明显低于对照组的(9.64±0.59)分,差异有统计学意义(P<0.05);研究组患儿术后不良反应发生率为17.78%,略高于对照组的13.33%,但差异无统计学意义(P>0.05)。结论七氟烷联合丙泊酚在儿童扁桃�Objective To study the anesthetic effect of sevoflurane combined with propofol in tonsillectomy of children and its influence on quality of recovery and stress response.Methods From April 2020 to April 2022,90 children with tonsillectomy who were admitted to Baoji People's Hospital were selected and randomly divided into a study group and a control group using a random number table method,each with 45 cases.The control group was anesthetized with propofol,while the study group was anesthetized with sevoflurane and propofol.The levels of heart rate(HR),mean arterial pressure(MAP),diastolic pressure(SBP),systolic pressure(DBP),and stress response[norepinephrine(NE),epinephrine(E),renin(R)]before anesthesia and 5 minutes after extubation were compared between the two groups.The awakening quality[awakening time,spontaneous breathing recovery time,consciousness recovery time,extubation time,awakening restlessness(PAED)score]and adverse reactions of two groups of children after 5 minutes of extubation were recorded and compared.Results Before anesthesia,there was no statistically significant difference in HR,MAP,SBP,and DBP between the two groups(P>0.05);after 5 minutes of extubation,HR,MAP,SBP,and DBP in both groups of children increased,and the levels of HR and MAP in the study group were(91.06±8.62)times/min and(77.18±5.86)mmHg,which were significantly lower than(98.95±9.26)times/min and(79.84±5.72)mmHg in the control group;the levels of SBP and DBP were(68.26±9.62)mmHg and(116.25±6.58)mmHg,which were significantly higher than(63.52±9.28)mmHg and(108.49±7.24)mmHg in the control group;the differences were statistically significant(P<0.05).Before anesthesia,there was no statistically significant difference in the levels of NE,E,and R between the two groups of children(P>0.05);after 5 minutes of exhumation,the levels of NE,E,and R in the two groups of children all increased,and the levels of NE,E,and R in the study group were(86.36±5.84)ng/mL,(101.32±6.58)ng/mL,and(4.06±0.53)ng/mL,which were significantly lo

关 键 词：儿童 扁桃体切除术 七氟烷 丙泊酚 诱导麻醉 苏醒质量 应激反应 不良反应 

分 类 号：R726.1[医药卫生—儿科]