丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术的研究

目的：研究新型丙泊酚靶控输注联合瑞芬太尼全凭静脉麻醉用于小儿短小手术的有效性和安全性,并与吸入麻醉作比较。方法：择期行短小手术患儿60例,年龄3～9岁,随机分为2组,每组30例。静脉组：应用新型小儿丙泊酚系统血浆3μg/mL靶控输注联合瑞芬太尼持续静脉输注0.2～0.3μg/（kg.min）以维持麻醉;吸入组：对照组,采用持续吸入3%～4%七氟烷维持麻醉;均置入喉罩行气道管理。于麻醉前（T0）、诱导毕（T1）、喉罩置入即刻（T2）、切皮（T3）、切皮后10 min（T4）及喉罩拔除即刻（T5）等时点记录心率（HR）、平均动脉压（MAP）、脑电双频谱指数（BIS）。术后记录麻醉苏醒时间、清醒程度（OAA/S评分）及不良反应。结果：T2～T5时点HR、MAP吸入组大于静脉组（P〈0.05或0.01）;T1～T5时点HR、MAP组内比较,静脉组差异无统计学意义,吸入组差异有统计学意义（P〈0.05）。与吸入组比较,静脉组苏醒时间降低、停药后10 min的OAA/S评分增高、术后烦躁及恶心呕吐例数减少、麻醉效果满意例数增高（P〈0.05）。结论：丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术,麻醉过程平稳,术中血流动力学稳定,应激反应较小,不良反应较少,术后恢复质量较好,是一种较理想的麻醉方法。

Study on total intravenous anesthesia with target-controlled infusion of propofol and continuous intravenous infusion of remifentanil in pediatric short duration surgery

AIM：To evaluate the anesthetic effect and the safety of total intravenous anesthesia（TIVA） with target-controlled infusion of propofol and continuous intravenous infusion of remifentanil in pediatric short duration surgery：comparison with total inhalational anesthesia. METHODS：60 pediatric cases suffered from short duration elective surgery were randomly divided into two groups,30 cases each group.The intravenous group and inhalation group（control group）.Patients in the intravenous group were anesthetized by TIVA with target controlled infusion of propofol（3 μg/mL） and remifentanil continuous intravenous infusion（0.2-0.3 μg·kg-1·min-1）.Patients in the control group were given inhalation of 3%-4% sevoflurane.The heart rate（HR）,mean arterial blood pressure（MAP） and spectral index（BIS） of the patients were recorded at time points：before induction（T0）,after induction（T1）,LMA insertion（T2）,skin incision（T3）,10 mins after skin incision（T4）,LMA extraction（T5）.Recording the awakening time,degree of vigilance（OAA/S scores） and postoperative adverse events.RESULTS：The HR and MAP of T2-T5 in control group were significantly higher than those in intravenous group（P0.05 or 0.01）.There were significantly different of T1-T5 values of HR and MAP in control group（P0.05）,but not in intravenous group（P0.05）.The awakening time in intravenous group was significantly shorter than that in control group（P0.05）.The OAA/S scores 10 mins after drug discontinuance were higher in intravenous group than those in control group（P0.05）.The occurrences of postoperative nausea,vomiting and restlessness were more frequently observed in patients in the control group than those in intravenous group（P0.05）.The anesthesia satisfactory ratio was higher in intravenous group than that in control group.CONCLUSION：TIVA with target-controlled infusion of profofol and continuous intravenous infusion of remifentanil displays stability in hemodynamics,less stress,rapid recovery,less complications,better clinical results in pediatric short duration surgery.