耳鼻喉儿科手术中联合使用舒芬太尼及瑞芬太尼的效果观察  

Efficacy of combined sufentanil and remifentanil in pediatric ear, nose, and throat surgeries

作　　者：王妮 赵哲 王敏[1] Wang Ni;Zhao Zhe;Wang Min(Second Department of Anesthesiology and Perioperative Medicine,Xi'an Children's Hospital,Xi'an 710003,Shaanxi Province,China)

机构地区：[1]西安市儿童医院麻醉与围术期医学科二科,西安710003

出　　处：《中国基层医药》2025年第2期228-233,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察舒芬太尼联合瑞芬太尼在小儿耳鼻喉手术麻醉中的应用效果。方法采用前瞻性研究设计, 选取2022年1月至2023年12月在西安市儿童医院接受择期耳鼻喉手术的患儿110例为研究对象, 采用随机数字表法分为对照组(55例)和观察组(55例)。全身麻醉中对照组仅使用舒芬太尼, 而观察组则在麻醉过程中同时使用舒芬太尼和瑞芬太尼。观察比较两组患儿在T1(麻醉诱导之前)、T2(气管插管时)、T3(手术开始时)、T4(手术开始后5 min)、T5(手术完成即刻)5个时间点的平均动脉压以及心率变化情况。对比两组患儿的自主呼吸恢复时间、睁眼时间、拔管时间、不良反应情况。对比两组患儿在T6(拔管后5 min)、T7(拔管后15 min)、T8(拔管后30 min)3个时间点的拉姆塞(Ramsay)镇静评分情况。对比两组患儿在T8(拔管后30 min)、T9(拔管后60 min)、T10(拔管后90 min)3个时间点的疼痛视觉模拟评分(VAS)情况。结果两组患儿在T1~T5时平均动脉压、心率, T6~T8时Ramsay镇静评分, T8~T10时VAS评分等差异均有统计学意义(F=152.93、2718.29、2347.47、751.77, 均P < 0.05)。观察组患儿的自主呼吸恢复时间[(5.37±2.18)min比(6.74±2.42)min]、睁眼时间[(9.03±2.02)min比(10.84±3.11)min]、拔管时间[(13.22±4.22)min比(16.47±5.14)min]均显著短于对照组患儿(t=3.11、3.62、3.62, 均P < 0.001)。观察组患儿的不良反应发生率低于对照组患儿[3.64%(2/55)比16.36%(9/55)](χ^(2)=4.94, P < 0.05)。结论舒芬太尼单用或联合瑞芬太尼在儿童耳鼻咽喉外科手术中都能取得很好的麻醉效果, 但舒芬太尼联合瑞芬太尼能明显缩短患儿自主呼吸恢复时间、睁眼时间及拔管时间, 减少不良反应, 改善手术效果, 有利于儿童手术后恢复。Objective:To investigate the efficacy of combined sufentanil and remifentanil in pediatric ear,nose,and throat surgeries.Methods:This study used a prospective study design.A total of 110 pediatric children who underwent elective ear,nose,and throat surgery at Xi'an Children's Hospital from January 2022 to December 2023 were included in this study.The patients were randomly divided into a control group(n=55)and an observation group(n=55)using a random number table method.In the control group,only sufentanil was used for general anesthesia,while the observation group received both sufentanil and remifentanil during the anesthesia process.The changes in average arterial pressure and heart rate were compared between the two groups at five time points:T1(before anesthesia induction),T2(during tracheal intubation),T3(at the start of surgery),T4(5 min after the start of surgery),and T5(immediately after surgery).Additionally,the recovery time for spontaneous breathing,the time to open eyes,extubation time,and adverse reactions were compared between the two groups.Ramsay sedation scores were compared between the two groups at three time points:T6(5 min after extubation),T7(15 min after extubation),and T8(30 min after extubation).Pain Visual Analog Score was compared between the two groups at T8(30 min after extubation),T9(60 min after extubation),and T10(90 min after extubation).Results:The differences in average arterial pressure and heart rate between the two groups at time points T1-T5,as well as Ramsay sedation scores at T6-T8 and Visual Analog Score scores at T8-T10,were all statistically significant(F=152.93,2718.29,2347.47,751.77,all P<0.05).In the observation group,the recovery time for spontaneous breathing[(5.37±2.18)min vs.(6.74±2.42)min],the time to open eyes[(9.03±2.02)min vs.(10.84±3.11)min],and extubation time[(13.22±4.22)min vs.(16.47±5.14)min]were significantly shorter in the observation group than in the control group(t=3.11,3.62,3.62,all P<0.001).The incidence of adverse reactions was significant

关 键 词：耳鼻喉外科手术 麻醉药 联用 动脉压 心率 儿童 舒芬太尼 瑞芬太尼 

分 类 号：R726.1[医药卫生—儿科]