瑞芬太尼复合丙泊酚靶控输注在小儿脑瘫手术中的应用

目的 评价瑞芬太尼复合丙泊酚全凭(TCT)静脉麻醉用于小儿脑瘫的临床效果.方法 选择择期需全麻下行肌力肌张力调整术或者行颈动脉剥脱术手术的患儿50例,随机分成A组和B组各25例.A组麻醉诱导(咪达唑仑0.2 mg/kg、丙泊酚1.0 mg/kg、瑞芬太尼1.5 μg/kg、琥珀胆碱2 mg/kg).麻醉维持连续靶控输注丙泊酚2~4 mg/(kg·h)微量持续泵注瑞芬太尼0.1~0.25 μg/(kg·min)能用肌松剂的维库溴胺0.03 μg/(kg·min)B组麻醉实施中麻醉诱导中瑞芬太尼改用芬太尼0.5~1 μg/kg麻醉维持中微量泵持续泵入瑞芬太尼改为间断推注芬太尼0.1 μg/(kg·min)其余药物使用方法及剂量同A组.结果 丙泊酚联合瑞芬太尼比丙泊酚联合芬太尼更能有效的控制麻醉诱导和手术过程中血压和心率的上升 并且使用瑞芬太尼组的患儿苏醒时间及拔管时间较使用芬太尼组明显缩短,术中丙泊酚的用量也大大减少.结论 丙泊酚联合瑞芬太尼适用于脑瘫患儿手术,且效果优于丙泊酚联合芬太尼.

Remifentanil and propofol with total intravenous anesthesia for pediatric cerebral palsy

Objective evaluation of propofol combined with remifentanil(TCT) with total intravenous anesthesia for pediatric cerebral palsy.Methods Selective required general anesthesia with muscle force and tension adjustment or carotid endarterectomy operation in 50 cases,were randomly divided into A group and B group with 25 cases in each group,Induction of anesthesia(group A midazolam propofol 0.2 mg/kg,1.0 mg/kg,1.5 μg/kg,remifentanil succinylcholine 2 mg/kg),Anesthetic maintenance of continuous propofol target controlled infusion 2~4 mg/(kg·h)] of continuous pump infusion of remifentanil 0.1~0.25 μg/(kg·min) can use the muscle relaxant vecuronium 0.03 μg/(kg·min)B group of anesthesia during induction of anesthesia with remifentanil and fentanyl in using 0.5~1 μg/kg anesthesia was maintained in trace pump continuously pumps the remifentanil to intermittent bolus injection of fentanyl 0.1 μg/(kg·min) remaining drugs usage and dosage with the A group,Results The of propofol combined with fentanyl than propofol in combination with fentanyl can effectively control the induction of anesthesia and operation process of the blood pressure and heart rate increased and the use of remifentanil group in recovery time and extubation time than the use of fentanyl group was significantly shorter,intraoperative dosage of propofol significantly reduced,Conclusion Propofol combined with remifentanil applied to children with cerebral palsy operation,and the effect is better than that of propofol in combination with fentanyl effect.