静脉或吸入麻醉诱导与维持对拔管后儿童围手术期呼吸系统不良事件的影响  

Effect of induction and maintenance of intravenous or inhalation anesthesia on respiratory system adverse events in children after extubation

作　　者：朱牡丹[1] 张春兰 ZHU Mudan;ZHANG Chunlan(Department of Anesthesiology,Tongling Municipal People’s Hospital,Tongling,Anhui 244000,China)

机构地区：[1]铜陵市人民医院麻醉科,安徽铜陵244000

出　　处：《重庆医学》2024年第20期3108-3112,3119,共6页Chongqing Medical Journal

摘　　要：目的观察静脉或吸入麻醉对拔管后儿童围手术期呼吸系统不良事件(PRAE)的影响。方法选取2023年7-12月该院在全身麻醉气管插管下行择期扁桃体和/或腺样体切除术的100例患儿为研究对象,根据随机数字表法分为静脉麻醉组和吸入麻醉组,每组50例。静脉麻醉组使用丙泊酚静脉诱导和维持,吸入麻醉组使用七氟烷吸入诱导和维持。记录两组拔管后PARE的发生率,麻醉维持期质量,术后恶心、呕吐、躁动发生情况。结果与吸入麻醉组比较,静脉麻醉组PRAE发生率(16.0%vs.42.0%)、氧饱和度降低发生率(14.0%vs.38.0%)、儿童苏醒期谵妄躁动(PAED)评分[5(2,8)分vs.6(4,11)分]更低,拔管时间更长[(19.6±10.6)min vs.(14.9±8.9)min],拔管后麻醉后监测治疗室(PACU)停留时间更短[(25.4±5.2)min vs.(27.9±6.4)min],差异有统计学意义(P<0.05)。两组插管时间、插管次数>1次和麻醉维持期发生吞咽及肢体活动的比例比较,差异无统计学意义(P>0.05)。两组诱导前后、插管后、拔管后4个时间点心率比较,差异无统计学意义(P>0.05);与诱导前比较,拔管后心率明显升高,差异有统计学意义(P<0.05)。结论小儿静脉麻醉时PARE发生率更低。Objective To observe the effects of intravenous or inhalation anesthesia on perioperative respiratory system adverse events(PRAE)in children after extubation.Methods A total of 100 children patients with elective tonsillectomy or adenoidectomy under general anesthesia endotracheal intubation in this hospital from July to December 2023 were selected as the study subjects and divided into the intravenous anesthesia group and inhalation anesthesia group according to the random number table method,50 cases in each group.The intravenous anesthesia group used propofol for venous induction and maintenance,while the inhalation anesthesia group used sevoflurane inhalation for induction and maintenance.The incidence rate of PRAE after extubation,anesthetic maintenance stage quality,incidence rates of postoperative nausea,vomiting and agitation were recorded in both groups.Results Compared with the inspiration anesthesia group,the PRAE incidence rate(16.0%vs.42.0%),hypoxia incidence rate(14.0%vs.38.0%)and pediatric anaesthesia emergence delirium(PAED)score[5(2,8)points vs.6(4,11)points]in the venous anesthesia group were lower,the extubation time was longer[(19.6±10.6)min vs.(14.9±8.9)min],postanesthesia care unit(PACU)stay time was shorter[(25.4±5.2)min vs.(27.9±6.4)min],the differences were statistically significant(P<0.05).The proportions of intubation time,intubation times>once and the swallow and limb activity during anesthetic maintenance had no statistical difference between the two groups(P>0.05).The heart rate had no statistical difference among 4 time points of before and after induction,after intubation and after extubation(P>0.05).Compared with before induction,the heart rate after extubation was significantly increased,and the difference was statistically significant(P<0.05).Conclusion The incidence rate of PARE in pediatric venous anesthesia is lower.

关 键 词：静脉麻醉 吸入麻醉 儿童 腺样体扁桃体切除术 围手术期呼吸系统不良事件 

分 类 号：R726.1[医药卫生—儿科]