丙泊酚联合瑞芬太尼喉罩通气与氯胺酮麻醉在小儿眼科手术的比较

目的通过对丙泊酚联合瑞芬太尼喉罩麻醉与氯胺酮复合丙泊酚麻醉在小儿眼科手术中的比较,探讨丙泊酚联合瑞芬太尼喉罩麻醉方法在小儿眼科手术中的可行性与安全性。方法选择该院66例择期眼科手术患儿,年龄1～8岁,ASAⅠ～Ⅱ级,随机分为二组：瑞芬太尼组（A组）和氯胺酮组（B组）。A组患儿缓慢静脉注射丙泊酚3 mg/kg和瑞芬太尼2μg/kg,待患儿体动消失、下颌松弛后置入喉罩,给予机械通气,以瑞芬太尼0.25～0.3μg/（kg·min）和丙泊酚8～10mg/（kg·min）静滴维持。B组肌肉注射氯胺酮6～8mg/kg和静脉注射丙泊酚2～3 mg/kg,保留患儿自主呼吸,面罩吸氧2L/min,以丙泊酚8～10μg/（kg·min）静滴维持,根据手术需要间断静脉注射氯胺酮0.5～1mg/kg。记录并分析二组患儿麻醉前（T1）,麻醉后5min（T2）,手术开始时（T3）,手术开始后10min（T4）以及手术结束时（T5）患儿的HR、MAP、SpO2、手术时间、患儿Aldrete评分达9分时间、麻醉恢复室（PACU）停留时间和围术期不良反应。结果 ①A组患儿在手术过程中HR和MAP的波动变化显著优于B组患儿（P〈0.05）;②二组患儿在手术时间上差异无统计学意义（P〉0.05）;③A组患儿在Aldrete评分达9分时间、离开PACU时间明显优于B组患儿（P〈0.05）;在术后躁动、恶心呕吐的发生率上,A组患儿显著低于B组患儿（P〈0.05）。结论小儿眼科手术中使用丙泊酚联合瑞芬太尼喉罩麻醉较使用氯胺酮麻醉效果好,可控性强,术后苏醒快,不良反应少,能够保证患儿围术期安全,是小儿眼科手术的新选择。

COMPARISON OF PROPOFOL COMBINED WITH REMIFENTANIL AND LARYNGEAL MASK ANESTHESIA AND KETAMINE INTRAVENOUS ANESTHESIA IN CHILDREN OPHTHALMOLOGIC SURGERY

Objective To explore the feasibility and safety of propofol combined with remifentanil with laryngeal mask in pediatric ophthalmology surgery by comparison of propofol combined with remifentanil and laryngeal mask anesthesia and ketamine intravenous anesthesia.Methods Sixty-six children,aged1 to 8,ASAⅠtoⅡ,scheduled for ophthalmology surgery were randomly divided into two groups：remifentanil group（group A）and ketamine group（group B）.The children in group A were given propofol 3mg/kg and remifentanil 2μg/kg by intravenous injection slowly,then inserted the laryngeal mask and assisted mechanical ventilation after body movement disappeared and jaw slack,the anesthesia was maintained by remifentanil 0.25～0.3μg/（kg·min）and propofol 810mg/（kg·min）.The children in group B were given intramuscular injection of ketamine 6-8mg/kg and intravenous injection of propofol 2-3 mg/kg,and the spontaneous breathing were kept and given oxygen mask 2L/min.The anesthesia was maintained by propofol 8-10mg/（kg·min）and intermittent intravenous injection of ketamine 0.5-1 mg/kg according to surgery requires.The changes of HR（heart rate）,MAP（mean arterial pressure）,SpO2 were recorded and analyzed at the time point before anesthesia（T1）,after anesthesia 5 min（T2）,at the start of surgery（T3）,after surgery began 10 min（T4）and at the end of surgery（T5）in two groups.And the operative time,the length of time of children Aldrete score to 9 points,the stay time of anesthesia recovery room（PACU）and perioperative adverse reactions were also recorded and analyzed.Results The changes of HR and MAP in group A during surgery were significantly better than that in group B（P〈0.05）.There was no statistically significant difference on operative time of the two group（P〉0.05）.Compared with group B,the length of time of children Aldrete score to 9 points and the stay time of PACU in group A were significantly shortened（P〈0.05）.In the incidence of postoperative agitation,nausea an