静吸复合麻醉和全凭静脉麻醉对小儿疝修补术后谵妄的影响对比

目的本研究拟对比静吸复合麻醉和全凭静脉麻醉对学龄前小儿患者疝修补术后谵妄的影响。 方法选择2016年9月至2017年8月，第八十二集团军医院收治的55例年龄<7岁、能清楚自我表达的学龄前儿童作为研究对象，择期在全身麻醉下行疝修补术，随机分为静吸复合麻醉组（Inh组）和全凭静脉麻醉组（Ven组）。采用2~3 mg/kg丙泊酚静脉麻醉诱导，术中麻醉维持采用静吸复合麻醉（七氟烷-瑞芬太尼）或全凭静脉麻醉（丙泊酚-瑞芬太尼），并且维持一定麻醉深度（BIS 45~55）。术后1 h、3 d，分别利用小儿麻醉后谵妄（the Pediatric Anesthesia Emergence Delirium，PAED）评定量表判定患者是否有谵妄表现。同时比较不同麻醉方式下麻醉苏醒时间、定向力恢复时间和患儿家属满意度。 结果Inh组和Ven组术后1 h的PAED评分分别为（7.44±0.71）分、（5.64±0.56）分，患儿家属对麻醉满意度评分分别为（3.82±0.29）分、（3.04±0.26）分，差异均有统计学意义（P<0.05）。Inh组和Ven组术后3 d的PAED评分中位数均为0，差异无统计学意义（P>0.05）。 结论相比全凭静脉麻醉（丙泊酚+瑞芬），静吸复合麻醉（七氟烷+瑞芬太尼）方式导致较多学龄前儿童疝修补术后早期发生谵妄。

Comparison of effects of intravenous inhalation combined anesthesia with total intravenous anesthesia on delirium after pediatric hernia repair

ObjectiveTo compare the effects of inhalation combined anesthesia and total intravenous anesthesia on postoperative delirium after hernia repair in preschool children. MethodsA total of 55 preschool children aged<7 years old who were able to express themselves clearly were enrolled. The patients underwent hernia repair were subjected to general anesthesia. They were randomly divided into inhalation combined anesthesia (Inh group) and total intravenous anesthesia (Ven group). General anesthesia was induced with 2 to 3 mg/kg propofol. Intraoperative anesthesia was maintained by intravenous inhalation (sevoflurane-remifentanil) or total intravenous anesthesia (propofol-remifentanil). Anesthesia depth were monitored by Bispectral index (BIS) ranging from 45 to 55. At 1 h and 3 d after operation, the Pediatric Anesthesia Emergence Delirium (PAED) rating scale was used to determine whether the patients had postoperative delirium. At the same time, the anesthesia emergence time, the recovery time of the orientation and the satisfaction of the family members of the children subjected to the two different anesthesia methods were compared. ResultsThe PAED scores at 1 h postoperatively in the Inh group and the Ven group were (7.44±0.71) scores and (5.64±0.56) scores, respectively, and the difference was statistically significant (P<0.05). The anesthesia satisfaction scores of the family members of the Inh group and the Ven group, measured at 1 h after surgery, were (3.82±0.29)scores and (3.04±0.26) scores, respectively, and the difference was statistically significant (P<0.05). The PAED scores at 3 d postoperatively in the Inh group and the Ven group were 0 (median) and 0 (median), respectively, and the difference was not statistically significant (P>0.05). ConclusionCompared with total intravenous anesthesia, inhalation combined anesthesia leads to more postoperative delirium after hernia repair in preschool children.