丙泊酚复合瑞芬太尼或七氟醚麻醉在儿童先天性心脏病介入治疗中的应用比较

目的观察丙泊酚复合瑞芬太尼或丙泊酚复合七氟醚联合喉罩麻醉用于儿童先天性心脏病介入治疗的可行性和临床效果比较。方法选择ASAI～Ⅱ级，择期行先天性心脏病介入治疗患儿40例，随机均分为丙泊酚＋瑞芬太尼（PR）组和丙泊酚十七氟醚（PS）组。所有患儿均静脉注射氯胺酮2mg·kg^-1基础麻醉。麻醉诱导采用丙泊酚2mg·kg^-1，PR组用瑞芬太尼1μg·kg^-1，PS组七氟醚吸入。待患儿意识消失下颌松弛后置入经典型喉罩。麻醉维持：PR组丙泊酚6mg·kg^-1·h^-1，瑞芬太尼0．05—0．1μg·kg^-1·min。持续输注，PS组丙泊酚6mg·kg^-1·h^-1，七氟醚1％～3％。观察2组诱导前（TO）、置喉罩时（T1）、置入喉罩后3min（T2）、手术结束（T3）及拔除喉罩（T4）各时点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、呼吸频率（RR）及呼气末二氧化碳分压（PETCO2）变化情况。观察术中及术后不良反应、苏醒时间等。结果在T1、他及B时点，2组HR、MAP及RR均较1、0时下降（P〈0．05）。与Ps组比较，PR组HR、MAP下降较明显，术后躁动、恶心呕吐发生率明显降低，但术后苏醒时间较长（P〈0．05）。2组在各时间点的SpO：无统计学差异。在T1、他时点PR组RR较PS组慢（P〈0．05），但对通气影响不大。结论丙泊酚复合瑞芬太尼或丙泊酚复合七氟醚麻醉都可安全用于儿童先天性心脏病介入治疗的麻醉管理，应用喉罩可相对更好地控制气道；丙泊酚复合七氟醚血流动力学更稳定，苏醒更迅速，但术后躁动、恶心呕吐发生率升高。

Comparison of the anesthetic effects of propofol combined with remifentanil or sevoflurane during interventional treatment of congenital heart disease in children

Objective To evaluate the feasibility and effects of laryngeal mask airway （LMA） and propofol combined with remifentanil or sevoflurane in interventional treatment of congenital heart disease in children. Methods 40 ASA Ⅰ-Ⅱchild patients were randomly divided into propofol ＋ remifentanil （PR） group and propofol ＋ sevoflurane （PS） group （20 in each） before intervention treatment of congenital heart disease. All patients underwent basic anesthesia by intravenous injection of 2 mg/kg ketamine followed by anesthesia induction with 2 mg/kg propofol. Then, the PR group received 1.0 g/kg of remifentanil , while the PS group inhaled sevoflurane. Next, LMA was applied in both groups once the patients became unconscious. For maintenance of anesthesia, 6 mg· kg ^-1· h ^- 1 of propofol and 0.05 - 0.1 μg·kg^-1 . min^-1 of remifentanil were delivered in the PR group through continuous infusion, while 6 mg· kg^-1·h^- 1 of propofol and 1% -3% of sevoflurane were given in the PS group. The mean arterial pressure （MAP） , heart rate （HR） , blood oxygen saturation （SpO2 ） , respiratory rate （RR） and partial pressure of end -tidal carbon dioxide （PETCO2） val-ues of both groups were recorded before induction （T0） , before and 3 rain after implantation of laryngeal mask （ T1 and T2 ） , at the end of surgery （ T3 ） and after removal of laryngeal mask （T4） . Also, intraoperative and postoperative adverse reactions and awakening time were observed. Results The levels of HR, MAP and RR of both groups were lower at T1, T2 and T3 than at TO （ P 〈 0.05 ）. Compared with the PS group, the PR group presented remarkable reduction in HR and MAP, lower incidences of restlessness, nausea and vomiting, but delayed recovery from anesthesia （ P 〈 0.05 ）. No statistical differences were found in SpO2 of both groups at each time point. The RR had little effect on ventilation despite lower RR were recorded at T1 and T2 in the PR group than that in the PS group （ P 〈 0.05 ）