瑞芬太尼复合利多卡因在小儿气管异物取出术中的应用

目的观察瑞芬太尼复合利多卡因在小儿气管异物取出术中的应用效果。方法气管异物患儿40例,随机分为R组和F组,每组20例。均入室后吸入七氟醚,入睡后行静脉穿刺,静脉穿刺后停止吸入七氟醚。之后R组静脉注射1%利多卡因3mg.kg-1,静脉泵注异丙酚50～150μg.kg-1.min-1、瑞芬太尼0.1～0.5μg.kg-1.min-1和静脉注射维库溴铵0.05 mg.kg-1维持麻醉(R组,n=20);F组静脉穿刺后不注射利多卡因,而是静脉泵注异丙酚50～150μg.kg-1.min-1、静脉注射芬太尼2μg.kg-1和静脉注射维库溴铵0.05 mg.kg-1维持麻醉(F组,n=20)。术中经硬质支气管镜侧孔行高频通气。记录各时点血流动力学变化,对比两组患儿术中体动、屏气呛咳、低氧饱和度(SpO2降至90%以下)、硬质气管镜退镜次数以及术后呛咳、躁动发生率,并比较手术时间和苏醒时间。结果两组术中患儿术中体动、低氧饱和度、支气管镜退镜次数、手术时间和术后躁动无统计学差别,R组术中、术后呛咳发生率少、苏醒更加迅速、术中血流动力学更稳定。结论瑞芬太尼复合利多卡因在小儿气管异物取出术中的应用,术中术后并发症少,苏醒迅速且苏醒质量高。

Remifentanil combined with lidocaine on tracheal and bronchial foreign body removal in children

Objective To investigate the effect of remifentanil combined with lidocaine on tracheal and bronchial foreign body removal in childi＇en. Methods 40 children undergoing tracheal and bronchial foreign body removal were assigned into group R and group F, with 20 children in each group. Each child in two groups was inhaled sevoflurane after entering the operation room, and then was complied veni- puncture after which the child was stopped inhaling sevoflurane. Hereafter,the child in group R was injected 1% lidocaine 3 mg ~ kg-1 , O. 05 mg ~ kg.-： vecuronium bromide and was pumped propofol and remifentanil with the speed of 50 ~ 150 p,g ~ kg-： ~ min- ： and O. 1 0.5 ~g ~ kg-I ~ min-1 respectively,while the child in group F was injected fentanyl 2 Ixg ~ kg-： ,0.05 mg ~ kg-I vecuronium bromide and was pumped propofol but was not injected 1% lidoeaine. High frequency jet ventilation was applied in two groups. Intraoperative body movement, cases of breath holding and bucklng, low oxygen saturation, the times of bronchoscopy removing and postoperative bucking, postoperative agitation and awaken time or operation time were all observed. Results There was no statistic significance in the difference of intraoperative body movement, low oxygen saturation, the times of bronchoscopy removing, postoperative agitation and operation time be- tween the two groups, but the child in group R had fewer intraoperative and postoperative bucking and woke up more quickly, and intraop- erative hemodynamic state in group R was more stable than that in group F. Coulusions Children undergoing tracheal and bronchial for- eign body removal with the application of reminiscential combined with lidocaine have fewer intraoperative or postoperative complication, wake up more quickly with higher recovery quality.