舒芬太尼复合七氟烷用于小儿扁桃体肥大手术的麻醉效果及安全性研究

目的探讨舒芬太尼复合七氟烷应用于小儿扁桃体肥大手术的麻醉效果及安全性。方法选取60例择期行扁桃体切除术的患儿,按入院顺序随机分为2组,每组30例。观察组患儿采用舒芬太尼联合七氟烷复合麻醉,对照组患儿采用瑞芬太尼联合丙泊酚复合麻醉。麻醉期间严密监测患儿生命体征等各项指标,详细记录两组患儿诱导时间、术后呼吸恢复时间、睁眼时间及拔管时间。同时观察并比较两组患儿入室后静卧5 min(T0)、气管插管后即刻(T1)、插管后5 min(T2)、扁桃体切除时(T3)、术毕拿出开口器(T4)、拔管后5 min(T5)各时间点的平均动脉压(MAP)、心率(HR)。比较两组患儿拔管后5 min、15 min、30 min的Ramsay镇静评分、躁动评分及FLACC镇痛评分,并对其中评分≥6分者给予镇痛治疗,对两组患儿术后镇痛情况进行比较。结果与对照组比较,观察组患儿诱导时间、呼吸恢复时间、睁眼时间及拔管时间均较对照组明显缩短,两组比较差异有统计学意义(P<0.05)。T0、T1、T2、T3、T4时间点,两组患儿MAP及HR比较差异无统计学意义(P>0.05);与T0比较,两组患儿T1、T2、T3时的MAP及HR明显降低,差异有统计学意义(P<0.05);在T5时,观察组患儿MAP及HR明显低于对照组,差异有统计学意义(P<0.05)。观察组患儿拔管后5 min、15 min、30 min时Ramsay评分明显低于对照组,FLACC评分明显高于对照组,差异有统计学意义(P<0.05)。观察组患儿拔管后5 min、15 min时躁动评分明显高于对照组,差异有统计学意义(P<0.05);拔管后30 min时,两组患儿躁动评分比较差异无统计学意义(P>0.05),观察组患儿术后无1例给予镇痛,对照组4例给予镇痛,两组比较差异有统计学意义(P<0.05)。结论舒芬太尼复合七氟烷麻醉应用于小儿扁桃体切除术中,具有良好的麻醉效果,术后麻醉恢复快且质量较好。

Effect and safety of sufentanil and sevoflurane anesthesia on children with tonsillar hypertrophy surgery

Objective To investigate the efficacy and safety of sufentanil and sevoflurane anesthesia used in children with tonsillar hypertrophy surgery. Methods 60 children undergoing elective tonsillectomy were randomly divided into two groups according to the order of admission ,patients in observation group were given combined anesthesia of sufentanil and sevoflurane, patients in control group were given combined anesthesia of remifentanil and propofol. The followed indexes were closely monitored：vitai signs etc. The induction time, postoperative respiratory recovery time, eye opening time and extubation time were recorded. The mean arterial pressure（ MAP）, heart rate（HR） at TO （ lying still for 5 min） , T1 （ immediately after intubation） , T2 （ 5 rain after intubation） , T3 （ tonsillectomy ）, T4 （ the moment just after the operation） and T5 （5 min after extnbation）of the two groups were compared. The Ramsay sedation score, agitation score and FLACC pain scores at 5 min, 15 min and 30 min after extubation of the two groups were compared, and the children（ ≥6 points）were given analgesic treatment. The postoperative analgesia of the two groups were compared. Results Compared with control group, the induction time, postoperative respiratory recovery time, eye opening time and extubation time of treatment group was significantly shorter, there were significant differences between the two groups （P 〈 0.05 ）. No significant difference was found in MAP and HR at TO, T1, T2, T3 and T4 between the two groups （ P 〉 0.05 ）. Compared with TO, the MAP and HR of the two groups at T1, T2, T3 were significantly lower （ P 〈 0.05 ） ; but at T5, the MAP and HR in treatment group were significantly lower than those of control group （ P 〈 0.05 ）. Compared with control group, the Ramsay scores in treatment groups at 5 min, 15 min and 30 rain after extuba- tion were significantly lower（ P 〈 0.05 ） , and the FLACC scores were significantly higher（ P 〈 0.05 ）. The agitation scores in treatment group at 5 min and 15 rain after extubation were significantly higher than those of control group （ P 〈 0.05 ）, and no significant difference was found in agitation score at 30 min after extubation between the two groups （ P 〉 0.05 ）. There were 0 case and 4 cases given analgesia in treatment group and control group, there were significant difference between the two groups （ P 〈 0. 05 ）. Conclusion The combined anesthesia of sufentanil and sevoflurane has good effect on pediatric tonsillectomy, with quick and good postoperative anesthesia recovery.