不同全身麻醉药物和方式在小儿眼科手术中的应用效果比较  

Comparison of different general anesthetic drugs and modalities in pediatric ophthalmic surgery

作　　者：程璠 Cheng Fan(Department of Anesthesiology,Kunming Aier Eye Hospital,Kunming,Yunnan 650200,China)

机构地区：[1]昆明爱尔眼科医院麻醉科,云南昆明650200

出　　处：《中国药物与临床》2024年第21期1401-1405,共5页Chinese Remedies & Clinics

摘　　要：目的探讨不同全身麻醉药物与方式在小儿眼科手术中的应用效果及安全性。方法按麻醉方法将昆明爱尔眼科医院2022年4月至2024年6月收治的年龄3~12岁的眼科患儿120例按麻醉法分为全凭静脉组及吸入麻醉组。全凭静脉组分为P组(丙泊酚喉罩组)、C组(环泊酚喉罩组);吸入麻醉组分为:A组(喉罩组)、B组(气管插管组),每小组各30例。麻醉诱导:P组使用丙泊酚(2 mg/kg)、瑞芬太尼(2μg/kg),C组使用环泊酚(0.4 mg/kg)、瑞芬太尼(2μg/kg),麻醉满意后置入喉罩。A组和B组使用丙泊酚(2 mg/kg)、舒芬太尼(0.5μg/kg)、顺苯磺酸阿曲库铵(0.15 mg/kg),麻醉满意后A组置入喉罩、B组行气管插管。术中麻醉维持使用微量泵输注瑞芬太尼0.1~1μg·kg^(-1)·min^(-1)加丙泊酚4~12 mg·kg^(-1)·h^(-1)(P组)或环泊酚0.8~2 mg·kg^(-1)·h^(-1)(C组)、A组和B组静脉泵注瑞芬太尼0.1~1μg·kg^(-1)·min^(-1)加吸入七氟烷2%~3%维持麻醉。记录各组不同时间点体征变化、术毕拔管时间,麻醉恢复指标、术后苏醒期躁动情况及不良反应发生情况。结果吸入麻醉组苏醒期躁动量化评分表(PAED)评分以及不良反应发生率均高于全凭静脉组,差异有统计学意义(P<0.05);P组注射痛的发生高于C组。在T2、T5阶段的心率、平均动脉压,B组较A组升高。插管或置入喉罩后各时间段平均气道压,B组高于A组。拔管时间各组差异无统计学意义(P>0.05)。结论小儿眼科手术采用全凭静脉麻醉较之吸入麻醉苏醒期躁动发生率低,血流动力学平稳,而使用环泊酚能降低注射痛发生率,小儿耐受性好。喉罩较气管插管可有效减少气道刺激,减少应激反应,避免眼压增高。因此,环泊酚喉罩全身麻醉用于小儿眼科手术安全有效,具有良好临床应用前景。ObjectiveTo explore the application effect and safety of different general anesthesia modalities in pediatric ophthalmic surgery.MethodsA total of 120 cases of ophthalmology children aged 3^(-1)2 years admitted to Kunming Aier Eye Hospital from April 2022 to June 2024 were divided into a general intravenous group and a inhalation anesthesia group according to the anesthesia method.Total intravenous group:group P(propofol laryngeal mask group),group C(cyclophenol laryngeal mask group);inhalation anesthesia group:group A(laryngeal mask group),group B(tracheal intubation group),30 cases in each group.Anesthesia induction:group P received intravenous propofol(2 mg/kg)plus remifentanil(2μg/kg),group C received intravenous cyclophenol(0.4 mg/kg)plus remifentanil(2μg/kg),and the laryngeal masks were placed after anesthesia was satisfied.The A and B groups received intravenous propofol(2 mg/kg),sufentanil(0.5μg/kg),and cisatracurium cisbenzenesulfonate(0.15 mg/kg),and after satisfactory anesthesia,a laryngeal mask was placed in group A and tracheal intubation was performed in group B.Intraoperative anesthesia maintenance:group P and group C were intravenously pumped with remifentanil 0.1^(-1)μg·kg^(-1)·min^(-1) plus propofol(group P)4^(-1)2 mg·kg^(-1)·h^(-1) or cyclophenol(group C)0.8-2 mg·kg^(-1)·h^(-1),group a and group b were intravenously pumped with remifentanil 0.1^(-1)μg·kg^(-1)·min^(-1) and inhalation of sevoflurane 2%-3%to maintain anesthesia.Changes in signs,extubation time at the end of the operation,anesthesia recovery indexes,postoperative agitation during the awakening period and the occurrence of adverse reactions were recorded at different time points in each group.ResultsThe score of the quantitative awakening period agitation rating scale(PAED)and the incidence of adverse reactions in the inhalation anesthesia group were higher than those in the total intravenous group,and the difference was statistically significant(P<0.05),and the incidence of injection pain was significantly higher in pr

关 键 词：二异丙酚 麻醉 全身 眼外科手术 治疗结果 儿童 

分 类 号：R726.1[医药卫生—儿科]