瑞芬太尼联合丙泊酚全静脉麻醉在小儿鼾症手术的应用

目的探讨瑞芬太尼联合丙泊酚全静脉麻醉在小儿鼾症手术中的应用。方法ASA（美国麻醉医师学会）～级择期行小儿鼾症手术患者100例,年龄5～15岁,随机分为两组,每组50例,组给予瑞芬太尼联合丙泊酚全静脉麻醉,组给予芬太尼、丙泊酚复合吸入异氟醚静吸复合麻醉。术中肌松药用阿曲库铵（0.8mg/kg）,术毕停药,观察麻醉诱导及气管插管时的血压、心率,停药后患者自主呼吸恢复时间,呼之睁眼时间,拔管时间,观察患者的术后疼痛及恶心呕吐等副反应情况。结果1组诱导时插管反应发生率低于组。2两组患者自主呼吸恢复时间无显著差异,但组呼之睁眼时间,拔管时间早于组。3组患者主诉疼痛的多于组,恶心呕吐发生率无差异。结论瑞芬太尼联合丙泊酚全静脉麻醉用于小儿鼾症手术的麻醉,诱导更平稳,苏醒质量更优良,但由于瑞芬太尼半衰期短,患者术后会感到疼痛,镇痛应及时开始。

The use of Remifentanil and Propofol during total intravenous anesthesia on the operation about children's snoring

Objective To inquire into the effects of Remifentanil and Propofol during total intravenous anesthesia on the operation of children＇s snoring. Methods 100 patients at ASA Ⅰ-Ⅱ , with age from five to fifteen, were selected and randomly divided into two groups. There were fifty cases in each group. Remifentanil and Propofol for inductiond and maintenance of anesthesia were used in group one, while Fentanil,Propofol and Sevoflurane in group two. Atracurium Besilate （0.8 mg/kg） was used in two groups for induction of anesthesia . The hemodynamics during induction anesthesia and recovery profiles was compared between two groups. Results ①More patients in group two had episodes of tracheal response than in group one. ②Times from stopping administration of anesthetics until full spontaneous respiration was similar for two groups . But times for eye open and tracheal extubation in group one were shorter than in group two. ③There were more requirements for post operative analgesic in group one. The rates of post operative nausea or vomiting were similar. Conclusion Remifentanil and Propofol based anesthesia is associated with better hemodynamic stability and better recovery profile. Transition analgesic should be administrated immediately after the end of Remifentanil anesthesia because of its short context- sensitive half time.