瑞芬太尼联合小剂量舒芬太尼对小儿先天性心脏病介入手术血流动力学和术后麻醉恢复的影响

目的：探讨瑞芬太尼（REM）联合小剂量舒芬太尼（SUF）对小儿先天性心脏病（CHD）介入手术血流动力学和术后麻醉恢复的影响。方法：选取2019年1月至2021年1月在陆军第八十一集团军医院实施房间隔缺损和室间隔缺损封堵术的64例患儿，随机分为观察组和对照组各32例。对照组患儿采用REM进行麻醉，观察组患儿在对照组的基础上联合小剂量SUF进行麻醉。观察两组患儿麻醉诱导前（T1）、麻醉诱导后（T2）、气管插管后（T3）、切皮劈胸骨后（T4）和阻断开放后（T5）血流动力学指标平均动脉压（MAP）、心率（HR）、收缩压（SBP）、舒张压（DBP）]、观察两组患儿手术前后降钙素原（PCT）、C-反应蛋白（CRP）、皮质醇（Cor）指标，记录两组患儿手术时间、麻醉时间、术后呼吸恢复时间、拔管时间、新生儿术后疼痛评估量表（CRIES）评分以及术后呼吸抑制、恶心、呕吐、苏醒期躁动等术后并发症发生情况。结果：两组患儿T1、T2、T3、T4、T5各时间点的血流动力学指标比较差异无统计学意义（P>0.05）；术后，观察组患儿血清PCT、CRP、Cor水平低于对照组（P<0.05）；观察组患儿手术时间与麻醉时间与对照组比较差异无统计学意义（P>0.05），但术后呼吸恢复时间和拔管时间均短于对照组（P<0.05）；观察组患儿术后CRIES总评分低于对照组（P<0.05）；观察组患儿术后并发症发生率低于对照组（P<0.05）。结论：REM联合小剂量SUF用于小儿CHD介入术麻醉，可有效维持术中血流动力学稳定，且能缩短术后呼吸恢复时间，减少术中应激反应，且能有效降低术后并发症发生率。

Effects of Remifentanil Combined with Low-Dose Sufentanil on Hemodynamics and Postoperative Anesthesia Recovery in Interventional Surgery for Congenital Heart Disease in Children

Objective: To explore the effects of remifentanil (REM) combined with low-dose sufentanil (SUF) on hemodynamics and postoperative anesthesia recovery in interventional surgery for congenital heart disease in children. Methods: A total of 64 children undergoing closure of atrial septal defect and ventricular septal defect in the 81st Army Hospital from Jan. 2019 to Jan. 2021 were extracted to be randomly divided into the observation group and the control group, with 32 cases in each group. The control group was treated with REM for anesthesia, while the observation group was additionally given low-dose SUF for anesthesia based on the control group. The hemodynamics indicators such as mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) before anesthesia induction (T1), after anesthesia induction (T2), after tracheal intubation (T3), after sternum incision (T4) and after closure opening (T5) were observed. Procalcitonin (PCT), C-reactive protein (CRP) and cortisol (Cor) before and after surgery in both groups were detected. The surgery time, anesthesia time, recovery time of postoperative respiratory, extubation time, scores of crying, requires increased oxygen administration, increased vital signs, expression and sleeplessness (CRIES), and the incidence of postoperative complications such as respiratory depression, nausea, vomiting and emergence agitation in both groups were recorded. Results: There was no significant difference in hemodynamics indicators between two groups at T1, T2, T3, T4 and T5 (P>0.05). After surgery, the serum levels of PCT, CRP and Cor in the observation group were significantly lower than those in the control group (P<0.05). The difference in surgery time and anesthesia time between two groups was not statistically significant (P>0.05), yet the recovery time of postoperative respiratory and extubation time in the observation group were shorter than those in the control group (P<0.05). The total score of CRIES in the observation group was lower than that in the control group (P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group (P<0.05). Conclusion: REM combined with low-dose SUF for intervention anesthesia of children with congenital heart disease can effectively maintain the stability of intraoperative hemodynamics, shorten the recovery time of postoperative respiratory, reduce the intraoperative stress response and effectively decrease the incidence of postoperative complications.