不同药物配伍用于小儿手术麻醉的效果比较

目的比较氯胺酮、七氟醚、舒芬太尼、瑞芬太尼用于小儿头颈部手术麻醉的血流动力学变化及苏醒质量。方法选择择期头颈手术小儿100例,随机分为A组:氯胺酮;B组:氯胺酮、瑞芬太尼;C组:七氟醚;D组:舒芬太尼、丙泊酚;E组:瑞芬太尼、丙泊酚(n=20)。记录插管前、插管时、术中10min、手术结束时和清醒拔管时的平均动脉压(MAP)、心率(HR),观察手术结束至患儿的自主呼吸恢复时间、睁眼时间、拔管时间及拔管后躁动情况。结果插管时和清醒拔管时的MAP和HR,B、C、D、E组低于A组(P<0.05),术毕自主呼吸恢复时间、睁眼时间、苏醒拔管时间C、E组短于A组(P<0.01),B、D组也短于A组(P<0.05)。结论与氯胺酮比较,瑞芬太尼、舒芬太尼用于小儿手术的麻醉更有利于血流动力学的稳定和缩短苏醒时间,舒适度高。

Comparison of Different Anesthetic Drugs in Pediatric Patients during General Anesthesia

Objective To compare the effects ofketamine, sevoflurane, sufentanil and remifentanil in pediatric patients during general anesthesia. Methods 100 children （ASA Ⅰ -Ⅱ , 1 - 6 years old） were randomly divided into five groups of twenty each, including ketamine group （group A）, ketamine remifentanil group （group B）, sevoflurane group （group C）, sufentanil propofol group （group D）, remifentanil propofol group （group E）. The changes of MAP, FIR were observed during anesthesia, the recovery of spontaneous breathing time, waking time, extubation time and complication related to recovery and extubation were recorded. VP, S and Ramsay score were measured during postoperation. Results Compare with group A, group B, C, D, E had good hemodynamic stability during the procedure of intubation and extubation （P 〈0.05）. There were significant differences on spontaneous breathing time, extubation time, waking time between group A and group C, E （P 〈0.01）, and group B, D （P 〈0.05）. But Group D, E had higher sedation score and lower agitation score compared to the other groups during postoperation （P 〈0.05）. Conclusions Remifentanil or sufentanil combination of propofol produce superior and safer anesthesia than ketamine and with fewer side effects in pediatric patients during general anesthesia.