靶控输注丙泊酚和舒芬太尼用于小儿阻塞性睡眠呼吸暂停低通气综合征手术的临床观察

目的探讨靶控输注(TCI)丙泊酚和舒芬太尼用于小儿阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术的麻醉效果和对患儿循环及对苏醒期躁动的影响。方法选择小儿OSAHS患者40例,随机分为舒芬太尼组(S组)和雷米芬太尼组(R组),每组20例;S组采用效应室靶控输注(TCIe)丙泊酚、舒芬太尼,罗库溴铵0.6 mg/kg诱导,TCIe丙泊酚和舒芬太尼维持;R组采用TCIe丙泊酚、雷米芬太尼,罗库溴铵0.6 mg/kg诱导,TCIe丙泊酚和雷米芬太尼维持;观察记录两组患者基础值(T0)、诱导期最低值(T1)、插管后即刻(T2)、插管后3 min(T3)、插管后5 min(T4)、拔管时(T5)各时点的SBP、DBP、HR以及苏醒期躁动情况、苏醒时间和拔管时间。结果 R组T1时点血压和心率明显低于S组(P0.05);T5时点血压和心率R组均高于S组(P0.05);R组苏醒期躁动明显多于S组;而苏醒时间和拔管时间S组长于R组。结论 TCI舒芬太尼应用于小儿OSAHS麻醉诱导期和拔管期对血压和心率的影响均低于雷米芬太尼,苏醒期躁动比雷米芬太尼少,更有优势;在苏醒时间和拔管时间上长于雷米芬太尼,但苏醒后患者安静、平稳,更符合舒适化医疗要求。

Clinical observation of the surgery on children OSAHS with target-controlled infusion of propofol and sufentanil

Objective To observe the clinical effects of the surgery on children OSAHS with target-controlled infusion of propofol and sufentanil and the influence of postoperative results.Methods Forty children with obstructive sleep apnea hyperpnoea syndrome(OSAHS),ASA Ⅰ~Ⅱ,were randomly divided into sufentanil group(group S) and remyfentanil(group R).In group S,the power ark Ⅲ type target-controlled pump room effect was used to inject the propofol and sufentanil and the anaesthesia was induced with rocuronium 0.6mg/kg,and maintained with target-controlled injection of the propofol and sufentanil.In group R,the anaesthesia was induced with target-controlled injection of the propofol,remyfentanil and rocuronium 0.6mg/kg,and maintained with target-controlled infusion of propofol and remyfentanil.Systolic blood pressure(SBP),diastolic blood pressure(DBP),HR in different time points such as initial time(T0),time in induction phase(T1),microtime in tracheal intubation(T2),at three minutes after intubation(T3),at five minutes after intubation(T4) and the moment in drawing tube(T5) and the situation of awakening restless and revive time and decannulation time were monitored during anesthesia and these indices were recorded and compared between the two groups.Results The blood pressure(BP) and heart rate(HR) at T1 in group R were significantly lower than those in group S(P<0.05),while BP and HR at T5 in group R were markedly higher than those in group S(P<0.05);restlessness in anesthesia recovery period in group R was obviously more than that in group S,while the time of recovery and drawing tube(T5) in group S were obviously longer than those in group R(P<0.05).Conclusion The influence of target-controlled infusion of sufentanil applied to induction period of anesthesia and decannulation period of children OSAHS on BP and HR is lower than the influence of remyfentanil on BP and HR,but the restlessness in anesthesia recovery period in sufentanil group is less than that in remyfentanil group,which implies sufentanil has more advantages than remyfentanil has.The time of recovery and drawing tube(T5) in group S is obviously longer than those in group R,which signifies that sufentanil can make the patients quiet and steady after awaking,so sufentanil more meets the medical comfortable requirements.