不同麻醉方法用于小儿扁桃体、腺样体切除术中的比较

目的 不同的麻醉方法用于扁桃体、腺样体切除的患儿血流动力学、术后苏醒过程及并发症发生的情况，探讨适合于小儿较为安全、有效的麻醉与镇痛方法。方法选择ASAⅠ级择期行扁桃体及腺样体切除术的患儿90例，随机分为3组，Ⅰ组：芬太尼-异氟醚静吸复合全麻组；Ⅱ组：瑞芬太尼-丙泊酚全凭静脉麻组；Ⅲ组：瑞芬太尼-丙泊酚-曲马多全凭静脉麻组，每组30例。术中分别记录三组患儿诱导前（T1）、插管时（T2）、腺样体切除时（T3）、拔管后即刻（T4）、清醒时（T5）各时间点SBP、DBP、HR、SPO2；观察3组患儿停药至气管拔管，苏醒及清醒的时间，拔管后上呼吸道梗阻或屏气，躁动，恶性、呕吐发生的情况，以及在恢复室30min时疼痛的评分。结果3组患儿麻醉诱导前、插管时、腺样体切除时，血压、心率、氧饱和度的变化无统计学意义（P〉0．05k拔管后即刻，Ⅰ组血压、心率分别高于Ⅱ组、Ⅲ组，差异有统计学意义（P〈0．05）Ⅱ组血压、心率、氧饱和度与Ⅲ组相比差异无统计学意义（P〉0．05）。停药至气管拔管时间，苏醒时间，清醒时间，Ⅰ组分别长于Ⅱ组和Ⅲ组，差异有统计学意义（P〈0．05）Ⅱ组与Ⅲ组相比差异无统计学意义（P〉0．05）。上呼吸道梗阻或屏气、恶心呕吐、躁动I组明显多于Ⅱ组和Ⅲ组，差异有统计学意义（P〈0．05）Ⅱ组与Ⅲ组相比差异无统计学意义（P〉0．05）。术后疼痛评分，Ⅱ组明显高于Ⅰ组和Ⅲ组，差异有统计学意义（P〈0．05）Ⅱ组与Ⅲ组相比差异无统计学意义（P〉0．05）。结论瑞芬太尼复合丙泊酚维持术中的麻醉，手术结束停药即给予曲马多，可获得良好的麻醉效果，诱导平稳，苏醒快，质量高。

Comparison among different anesthesia methods for tonsillectomy and adenoidectomy in children

Objective To compare the advantages and the disadvantnges among the different anesthesia methods in children for tortsillectomy and adenoidectomy.Methods 90 cases with ASA Ⅰscheduled for tonsillectomy and adenoidectomy.The children were. randomly divided into three, groups.Patients in group Ⅰ received Fentanil combined with Isoflurane general anesthesia;patients in group Ⅱ received Remifentanil combined with Propofol general anesthesia and patients in group Ⅲ received Remifentanil combined with Propofol and Tramadol general anesthesia.Observing SBP、DBP、HR、SPO2 at the time that before inducing, inserting tube, adenoidectomy, pulling out tube, the recovery time, incidental of side effect, and post operative pain score VAS.Results Tthere were no significant difference on the SBP、DBP、HR、SPO2 at the time before induction, ntubation.After adenoidectomy in these three groups (P > 0.05). SBP、DBP、HR in group Ⅰ were larger than in group Ⅱ，Ⅲ (P < 0.05) at the time after extuhation. The recovery time of anesthesia was significantly longer in the group Ⅰ than in the group Ⅱ,Ⅲ incidena of the upper respiratory tract obstruction,nausea,vomiting, and restless more were higher in the group Ⅰ than in the group Ⅱ,Ⅲ (P < 0.05).Post operative pain score was significantly higher in the group Ⅱ than in the group Ⅰ and Ⅲ(P < 0.05). Conclusions remifentanil combined with Propofol and Pramadol general anesthesia is a effective anes-thesia methods for tonsillectomy and adenoidectomy in children,and it can wake induce stably,recover fast, and completely.