瑞芬太尼复合丙泊酚全凭静脉麻醉在小儿扁桃体手术中的应用

目的 探讨瑞芬太尼复合丙泊酚全凭静脉麻醉用于小儿扁桃体手术的临床疗效和安全性.方法 将择期行扁桃体切除术的患儿50例按随机数字表分为瑞芬太尼组(R组)和芬太尼组(F组),每组25例.麻醉诱导:R组予瑞芬太尼1μg·kg(-1)(稀释后缓慢注射),F组用芬太尼3μg·kg(-1),其他用药均相同,为咪达唑仑0.1mg·kg(-1),丙泊酚2mg·kg(-1),阿曲库钱0.5mg·kg(-1);麻醉诱导后:R组持续输注瑞芬太尼、丙泊酚;F组持续吸人异氟醚维持麻醉.记录2组诱导前(T0)、诱导后(T1)、插管时(T2)、手术开始后5 min(T3)、拔管时(T4)的MAP,HR,记录2组自主呼吸恢复时间、拔管时间、再入睡率等.结果 2组T0,T1的MAP和HR差异无统计学意义(P>0.05);R组T2,T3,T4的MAP,HR均低于F组(均P<0.05);R组苏醒时间、拔管时间、再入睡率均少于F组(均P<0.05).结论 瑞芬太尼复合丙泊酚全凭静脉麻醉用于小儿扁桃体手术较芬太尼、丙泊酚、异氟醚静吸麻醉围术期血流动力学更稳定,术后苏醒迅速.

Total Intravenous Anesthesia with Remifentanil and Propofol in Pediatric Tonsillectomy

Objective To investigate the efficacy and safety of total intravenous anesthesia with remifentanyl and propofol in pediatric tonsillectomy.Methods Fifty pediatric patients,ASA classⅠ-Ⅱ,scheduled for elective tonsillectomy were randomly allocated to receive fentanyl 3 μg·kg-1（F group,n=25） or remifentanyl 1 μg·kg-1（R group,n=25）.All the patients were given midazolam 0.1 mg·kg-1,propofol 2 mg·kg-1and atracurium 0.5 mg·kg-1.After induction of anesthesia,R group received continuous infusion of remifentanil and propofol,and F group received inhaled isoflurane.Mean arterial blood pressure（MAP） and heart rate（HR） were measured before induction（T0）,after induction（T1）,at intubation（T2）,5 minutes after the beginning of surgery（T3）,and at extubation（T4）.Spontaneous breathing recovery time,extubation time and the rate of sleep again were recorded.Results There were no significant differences in MAP and HR between the two groups at T0 and T1（P0.05）.Compared with F group,the MAP and HR atT2,T3 and T4,recovery time,extubation time,and the rate of sleep again significantly decreased in R group（all P0.05）.Conclusion Total intravenous anesthesia with remifentanil and propofol in pediatric tonsillectomy can maintain perioperative hemodynamic stability and induce quick recovery compared with inhalation anesthesia with isoflurane.