靶控输注瑞芬太尼与吸入七氟醚用于小儿腭裂修复术的对比研究

目的研究靶控输注瑞芬太尼与吸入七氟醚麻醉在小儿腭裂修复术的临床效果。方法选择ASAⅠ-Ⅱ级先天腭裂修复术患者40例,随机分为观察组（Ⅰ）和对照组（Ⅱ）各20例。两组采用相同的静脉麻醉诱导后行气管内插管,维持机械通气。麻醉维持：Ⅰ组采用靶控输注瑞芬太尼,同时靶控输注丙泊酚;Ⅱ组采用吸入七氟醚,同时也靶控输注丙泊酚。分别于麻醉诱导前（T1）、诱导结束时（T2）、手术开始时（T3）、手术30分钟（T4）、拔管后1分钟（T5）几个时点,记录血压、心率、脉搏氧饱和度,并记录自主呼吸恢复、气管拔管和清醒时间,苏醒后躁动和恶心呕吐的发生情况。结果与诱导前相比,两组在麻醉诱导后的SBP、DBP、HR下降明显,I组气管拔管后1分钟HR变化显著高于Ⅱ组,呼吸恢复、气管拔管和清醒时间Ⅰ组明显缩短。结论瑞芬太尼—丙泊酚靶控全麻用于小儿腭裂修复术麻醉效果满意且术后苏醒快。

A comparison of target controlled infusion with remifentanil and inhalation with sevoflurane in cleft palate prosthesis in pediatric patients

Objective：To research the effect of target controlled infusion anesthesia with remifentanil and inbreathing sevoflurane on inhalation anesthesia in cleft palate prosthesis in pediatric patients. Methods ： Forty ASA Ⅰ-Ⅱ patients aged 4 - 10y, undergoing cleft palate prosthesis, were randomly allocated to Group Ⅰ （n = 20, anesthesia with remifenantil and propofol） and Group Ⅱ （n = 20, anesthesia with sevoflurane and propofol）. Anesthesia induction methods for all patients were alike. Anesthesia was maintained with remifentanil and propofol in Group Ⅰ and with sevoflurane and propofol in Group Ⅱ. SBP, DBP and HR in the patients in two groups were noted respectively in T1, T2 ,T3 ,T4 ,T5 and compared with pre-induction, and the time of breath recovery and extubation and awaking, incidence of vomit and restlessness were recorded. Results ： Compared with pre-induction, SBP, DBP in T2 in all patients descended obviously （ P 〈 0. 05 ） , 1 rain after extubation, HR change of Group Ⅰ was higher than Group Ⅱ （ P 〈 0. 05 ） , the time of breath recovery and awaking was shorter （ P 〈 0.05 ） in Group Ⅰ . The incidences of vomit and nausea in Group Ⅰ were lower than those in Group Ⅱ. Conclusion： Remifentanil TCI with Propofol is suitable for cleft palate prosthesis in pediatric patients.