阿芬太尼联合丙泊酚麻醉在小儿腹腔镜疝囊高位结扎术的效果观察

目的观察阿芬太尼联合丙泊酚麻醉在小儿腹腔镜疝囊高位结扎术的效果。 方法选择2017年7月至2022年6月珠海市中西医结合医院收治的150例行腹腔镜疝囊高位结扎术的患儿作为研究对象，行前瞻性研究，采用随机数字表法将患者分为3组，阿芬太尼组（50例）采用阿芬太尼联合丙泊酚麻醉，舒芬太尼组（50例）采用舒芬太尼联合丙泊酚麻醉，芬太尼组（50例）采用芬太尼联合丙泊酚麻醉。对比3组的麻醉效果及不同时刻的心率、平均动脉压（MAP）水平，记录麻醉时间、拔管时间、苏醒时间、丙泊酚用量、呛咳及围手术期并发症发生情况，评估麻醉苏醒期躁动（PAED）及苏醒期的儿童疼痛评估量表（CHEOPS）评分。 结果阿芬太尼组、舒芬太尼组与芬太尼组的麻醉总优良率分别为100.00%、98.00%、98.00%，并发症总发生率分别为8.00%、14.00%、16.00%，组间对比差异无统计学意义（P>0.05）。麻醉维持后1 min，3组的心率、MAP水平较麻醉诱导前明显降低（P<0.05），组间对比差异无统计学意义（P>0.05）；麻醉维持后30 min，3组的心率、MAP水平较麻醉诱导前明显降低，而阿芬太尼组高于舒芬太尼组及芬太尼组（P<0.05），舒芬太尼组与芬太尼组差异无统计学意义（P>0.05）；术毕即刻，3组的心率、MAP水平较麻醉诱导前明显降低，组间对比差异无统计学意义（P>0.05）。阿芬太尼组的麻醉时间、拔管时间、苏醒时间及丙泊酚用量明显低于舒芬太尼组及芬太尼组（P<0.05），舒芬太尼组及芬太尼组差异无统计学意义（P>0.05）。诱导期及苏醒期，阿芬太尼组的呛咳评分及呛咳发生率明显低于舒芬太尼组及芬太尼组（P<0.05），舒芬太尼组与芬太尼组差异无统计学意义（P>0.05）。阿芬太尼组的PAED评分明显低于舒芬太尼组及芬太尼组（P<0.05），CHEOPS评分稍低于舒芬太尼组及芬太尼组（P>0.05），舒芬太尼组及芬太尼组差异均无统计学意义（P>0.05）。 结论阿芬太尼联合丙泊酚麻醉有利于维持小儿腹腔镜疝囊高位结扎术中的血流动力学稳定，苏醒质量良好，并有效降低术中丙泊酚用量，减少呛咳及术后躁动等并发症的发生。

Effect of Alfentanil combined with Propofol anesthesia in laparoscopic high ligation of hernia sac in children

ObjectiveTo observe the effect of Alfentanil combined with Propofol anesthesia in laparoscopic high ligation of the hernia sac in children. MethodsA prospective study of 150 children who planned to receive laparoscopic high ligation of children's hernia sacs in the Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from July 2017 to June 2022 was conducted. The patients were divided into three groups using a random number table. The Alfentanil group (50 cases) received Alfentanil combined with Propofol anesthesia , the Sufentanil group (n=50) received Sufentanil combined with Propofol anesthesia and the Fentanyl group (n=50) received Fentanyl combined with Propofol anesthesia. Anesthesia effect , heart rate (HR) and blood pressure (MAP) levels at different times of the three groups were compared. Anesthesia time, recovery time, extubation time, dosage of Propofol, cough and perioperative complications of the three groups were recorded. The Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and the Pediatric Anesthesia Emergence Delirium Scale (PAED) scores during awakening were evaluated. ResultsThe overall excellent and good rates of anesthesia in the Alfentanil group, Sufentanil group and Fentanyl group were 100.00%, 98.00% and 98.00%, respectively, and the total incidence of complications in these three groups were 8.00%, 14.00% and 16.00%, respectively, without statistical significance (P>0.05). 1 min after anesthesia maintenance, the levels of heart rate (HR) and mean arterial pressure (MAP) in the three groups were significantly lower than those before anesthesia induction (P<0.05), but there was no statistical significance between the three groups (P>0.05). 30 min after anesthesia maintenance, the levels of HR and MAP in the three groups were significantly lower than those before anesthesia induction, while the levels in the Alfentanil group were higher than those in the Sufentanil group and the Fentanyl group (P<0.05), and there was no statistical significance between the Sufentanil group and the Fentanyl group (P>0.05). Immediately after the operation, the levels of HR and MAP in the three groups were significantly lower than those before anesthesia induction, but there was no statistical significance between the three groups (P>0.05). Anesthesia time, extubation time, recovery time and Propofol dosage in the Alfentanil group were significantly lower than those in the Sufentanil group and the Fentanyl group (P<0.05), but there was no statistical significance between the Sufentanil group and the Fentanyl group (P>0.05). The cough score and cough incidence in the Alfentanil group were significantly lower than those in the Sufentanil group and the Fentanyl group during the induction and awakening period (P<0.05), but there was no statistical significance between the Sufentanil group and the Fentanyl group (P>0.05). The PAED score of the Alfentanil group was significantly lower than that of the Sufentanil group and the Fentanyl group (P<0.05), while the CHEOPS score was slightly lower than that of the Sufentanil group and the Fentanyl group (P>0.05), but there was no statistical significance between the Sufentanil group and the Fentanyl group (P>0.05). ConclusionAlfentanil combined with Propofol anesthesia is beneficial to maintain hemodynamic stability and a good quality of recovery during laparoscopic high ligation of the hernia sac in children, effectively reduce the dosage of Propofol during the operation, and reduce the occurrence of complications such as choking and postoperative agitation.