靶控输注丙泊酚复合舒芬太尼或瑞芬太尼用于小儿腹腔镜疝环结扎术的麻醉

目的：评价小儿腹腔镜疝环结扎术中应用靶控输注丙泊酚复合舒芬太尼与瑞芬太尼的麻醉效果与安全性。方法将行腹腔镜疝环结扎术72例患儿，随机分为TCIS组和TCIR组，每组36例，TCIS组予靶控输注舒芬太尼复合丙泊酚诱导与维持麻醉，TCIR组予靶控输注瑞芬太尼复合丙泊酚诱导与维持麻醉。比较两组患儿围麻醉期血流动力学变化、术毕苏醒时间、气管拔管时间、丙泊酚用量和术后Riker镇静和躁动评分（SAS）评分、视觉模拟痛觉（VAS）评分。结果两组患儿在麻醉诱导前，各血流动力学指标差异无统计学意义（t分别=0.12、0.23、0.48、0.31，P均＞0.05）；与TCIS组患儿比较，TCIR组患儿在插管时（T1）的收缩压、舒张压较低，在拔管时（T2）收缩压、舒张压和心率较高，差异均有统计学意义（t分别=5.71、8.63；5.77、4.27、4.00，P均＜0.05）。两组患儿术毕苏醒时间、气管拔管时间和丙泊酚用量比较，差异均无统计学意义（t分别=0.91、1.14、0.94，P均＞0.05）。TCIS组患儿SAS、VAS评分均低与TCIR组，差异均有统计学意义（t分别=7.67、18.57，P均＜0.05）。结论靶控输注丙泊酚复合舒芬太尼用于小儿腹腔镜疝环结扎术，在围麻醉期血流动力学更加平稳、且能更加有效减少患儿术后躁动和疼痛，较复合瑞芬太尼效果佳。

Target-controlled infusion of propofol combined with sufentanil or remifentanil for anesthesia of laparoscopic her-nia ring ligation

Objective To evaluate the anesthetic effect and security of target-controlled infusion of propofol combined with sufentanil or remifentanil for anesthesia of laparoscopic hernia ring ligation. Methods A total of 72 cases of the la-paroscopic hernia ring ligation were randomly divided into TCIS group and TCIR group with 36 cases each. TCIS group was given with target-controlled infusion of sufentanil combined with propofol phenol to induce and maintain anesthesia. TCIR group were given remifentanil combined with propofol to induce and maintain anesthesia. The hemodynamic changes during anesthesia, recovery time, extubation time, the dosage of propofol, postoperative Riker sedation and restlessness score （SAS） score, visual analog pain score were compared. Results Before anesthesia induction, there were no significant differences in the hemodynamic indexes between two groups （t=0.12,0.23,0.48,0.31,P〉0.05）. Compared with the TCIS group, the systolic pressure and diastolic pressure of TCIR group at the time of intubation were significantly lower（t=5.71, 8.63,P〈0.05） while the systolic blood pressure, diastolic blood pressure and heart rate at the time of extubation were sig-nificantly higher （t=5.77,4.27,4.00,P〈0.05）. The differences of postoperative recovery time, extubation time and the dosage of propofol between two groups were not statistically significant （t=0.91,1.14,0.94,P〈0.05）. The SAS score and VAS score of TCIS group were significantly lower than that of the TCIR group（t=7.67,18.57,P〈0.05）. Conclusion Tar-get-controlled infusion of propofol combined with sufentanil for laparoscopic hernia ring ligation in perianesthesia has more stable hemodynamics and can be more effective in reducing postoperative agitation and pain in children which is better than remifentanil.