靶控输注异丙酚在睡眠呼吸暂停综合征患儿的应用

目的比较靶控输注异丙酚与七氟醚吸入麻醉对阻塞性睡眠呼吸暂停综合征（obstructivesleep apnea syndrome,OSAS,即鼾症）患儿血流动力学的影响及苏醒期的特点。方法选择择期行悬雍垂-腭-咽成形术（uvulopalatopharyngoplasty,UPPP）的OSAS患儿36例,随机分为靶控输注（T）与七氟醚（S）两组。T组（n=18例）诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及维库溴铵0.1mg/kg后插管,维持采用瑞芬太尼0.2μg/（kg.min）＋血浆靶控输注异丙酚3μg/ml,在手术结束前5min停药。S组（n=18例）诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及维库溴铵0.1mg/kg后插管,维持采用维持采用瑞芬太尼0.2μg/（kg.min）＋七氟醚（维持呼出浓度在0.8~1.2MAC）静吸复合麻醉,手术结束前5min停药。记录诱导前、诱导后、插管后、切皮后、切皮后20、40min、拔管后、拔管后20、40min的MAP、HR;两组手术时间、手术结束至拔管的时间、术中肌松药总量及术后躁动、恶心呕吐、疼痛等不良反应。结果T组患者在术中血流动力学方面比S组患者平稳,拔管时间较S组短,且术后躁动、恶心呕吐较S组发生率低（P〈0.05）;T组与S组患者在术后疼痛评分差异无显著性。结论靶控输注异丙酚用于鼾症患儿有较明显的临床使用价值。

Application of propofol target controlled infusion in OSAS

Objective The purpose of this study is to evaluate the clinical efficacy of propofol target controlled infusion in uvulopalatopharyngoplasty （UPPP） surgery. Methods Thirty six ASA Ⅰ-Ⅱ patients undergoing UPPP surgery were randomly divided into two groups：T group （ propofol target controlled infusion, n = 18 ） and S group （sevoflurane, n = 18 ）. Patients in T group were induced with fentanil 2 μg/kg, propofol 2. 5 mg/kg and vecuronium 0. 1 mg/kg and maintained with remifentanil 0. 2μg/（ kg·min） and propofol target controlled infusion at the target effect-site concentration 3.0 μg/ml, while those in S group were induced with fentanil 2 μg/kg,propofol 2. 5 mg/kg and vecuronium 0. 1 mg/kg and maintained with remifentanil 0. 2 μg/ （ kg·min） and exhaling isoflurane （ MAC ：0. 8-1.2 ）. Results The hemodynamics of patients of different time points were more stable in T group. The time of extubation was shorter and the level of wakeness was much better in T group. Conclusion The anesthesia method of propofol target controlled infusion is an ideal method in OSAS undergoing UPPP surgery.