丙泊酚联合瑞芬太尼在小儿肝穿刺活检中的应用

目的探讨丙泊酚联合瑞芬太尼静脉麻醉在小儿行门诊肝穿刺活检中的应用效果及安全性。方法择期在门诊治疗室行B超引导下肝穿刺活检的患儿40例,分为两组:单纯丙泊酚组(A组,n=20)及丙泊酚联合瑞芬太尼组(B组,n=20)。A组在皮肤消毒前予以2.5～3.5mg/kg丙泊酚缓慢静推,B组则予1.5～2.5 mg/kg丙泊酚+0.5μg/kg瑞芬太尼缓慢静推;穿刺过程中若患儿出现躁动则立即追加10～30 mg丙泊酚加深麻醉。记录麻醉前(T_0)、麻醉后1 min(T_1)、术毕时(T_2)及返回病房时(T_3)的平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_2);比较两组丙泊酚用量、呼吸抑制率、术中躁动发生率及术后初醒时间(t)。结果两组患儿的年龄、性别、体重、ASA分级等一般情况无统计学差异(P0.05);A组T_1、T_2时刻MAP较麻醉前(T_0)下降(P0.05),而同时刻点两组HR、SpO_2无显著改变(P0.05);丙泊酚用量、躁动发生率和初醒时间A组皆大于B组(P0.05),呼吸抑制率两组无明显差异(P0.05)。结论在小儿肝穿刺活检的门诊手术中,单纯推注丙泊酚和丙泊酚联合瑞芬太尼两种方案都安全可行。在吸氧状态下,丙泊酚联合瑞芬太尼静脉麻醉方案相对优于单纯丙泊酚镇静。

Effect of propofol?remifentanil on liver biopsy in children

Objective To investigate the effect and safety of intravenous anesthesia with propofol combined with remifentanil in children undergoing hepatic biopsy. Method We selected 40 children undergoing hepatic biopsy as subjects， aged 3 to 13 years old， ASA Ⅰ-Ⅱ. The patients were randomized divided into two groups， the propofol group （group A， n=20） and the propofol combined with remifentanil group （group B， n=20）. Patients in group A were given 2.5-3.5 mg/kg propofol before abdominal skin disinfection intravenously. Patients in group B were given 1.5-2.5 mg/kg propofol and 0.5 μg/kg remifentanil before abdominal skin disinfection intravenously. 10-30 mg of propofol was added if the child was agitated during the puncture. The following targets were recorded：the mean arterial pressure （MAP）， heart rate （HR）， pulse oximetry （SpO2）； the total amount of propofol； the agitation during the puncture and the time to wake up （t）. Results There were no significant differences in the age， sex， weight， and ASA grade between the two groups （P>0.05）. The MAP of T1 and T2 in group A was lower than that before anesthesia （T0） （P<0.05）. There were no significant changes in HR and SpO2 between the two groups （P>0.05）. The dose of propofol， the incidence of agitation and the waking time were higher in group A than in group B （P<0.05）. There was no significant difference in respiratory inhibition rate between the two groups （P>0.05）. Conclusion Intravenous anesthesia with propofol combined with remifentanil is safe and feasible in children undergoing hepatic biopsy.