瑞芬太尼-丙泊酚靶控输注维持麻醉在小儿扁桃体摘除术中的应用效果及对患儿围术期血流动力学的影响
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摘要
目的探究瑞芬太尼-丙泊酚靶控输注维持麻醉在小儿扁桃体摘除术中的应用效果及对患儿围术期血流动力学的影响。方法选取我院2016年2月—2017年6月收治的78例拟行扁桃体摘除术的扁桃体肥大患儿为研究对象,采用随机数字表法分为观察组40例和对照组38例。观察组术中采用瑞芬太尼-丙泊酚靶控输注维持麻醉;对照组术中采用丙泊酚和芬太尼麻醉诱导,异氟烷吸入维持麻醉。比较两组患儿围术期不同时间点血流动力学指标[平均动脉压(MAP)和心率(HR)]变化;术后自主呼吸恢复时间、睁眼时间、拔管时间及离开恢复室时间;两组患儿拔管即刻、拔管后10 min、离开恢复室时躁动评分和Ramsay镇静评分;术后不良反应发生情况。结果两组患儿术前、插管后1 min、清醒时MAP、HR水平比较差异均无统计学意义(P>0.05),观察组置入开口器时、扁桃体切除时、拔管时MAP、HR水平显著低于对照组(P<0.05);术后观察组自主呼吸恢复时间、睁眼时间、拔管时间及离开恢复室时间均显著短于对照组,差异均有统计学意义(P<0.05或P<0.01);观察组患儿拔管即刻、拔管后10 min、离开恢复室时躁动评分均显著低于对照组,Ramsay镇静评分显著高于对照组,差异均有统计学意义(P<0.05);术后观察组总不良反应发生率为2.50%显著低于对照组的10.53%,差异有统计学意义(P<0.05)。结论瑞芬太尼-丙泊酚靶控输注维持麻醉可维持扁桃体摘除术患儿围术期血流动力学的稳定,缩短术后恢复时间,安全高效。
Objective To explore application effect of remifentanil-propofol by target controlled infusion(TCI) to maintain anesthesia of children undergoing tonsillectomy and their effect on perioperative hemodynamics. Methods Seventy-eight children with tonsil hypertrophy undergoing tonsillectomy in our hospital from February 2016 to June 2017 were selected as the objects, and then divided into observation group(n=40) and control group(n=38) according to random number table. In the control group, anesthesia was induced with propofol and fentanyl, and maintained with isoflurane inhalation, while the observation group was given remifentanil-propofol by TCI to maintain anesthesia. Hemodynamic parameters [mean arterial pressure(MAP) and heart rate(HR)] at different time points during the perioperative period were compared between the two groups. After operation, the time of spontaneous breathing recovery, eye opening time, extubation time, and time to discharge from the recovery room were compared. Agitation score and Ramsay sedation score in both groups were compared immediately after extubation, 10 min after extubation and when discharged from the recovery room. In addition, postoperative adverse reactions were recorded. Results There was no significant difference in MAP and HR before operation, 1 min after intubation and after regaining consciousness between the two groups(P>0.05). The MAP and HR levels were significantly lower in observation group at the time when mouse gag was placed, when the tonsils were removed, and when extubation was performed, as compared with those in control group(P<0.05). After operation, the time of spontaneous breathing recovery, eye opening time, extubation time, and time to discharge from the recovery room were significantly shortened in observation group than in control group, suggesting significant differences(P<0.05, P<0.01). Agitation scores in observation group were significantly lower than those in the control group immediately after extubation, 10 min after extubation and time to discharge from the recovery room(P<0.05), and Ramsay sedation scores were significantly higher than those in the control group(P<0.05). The incidence of total adverse reactions after operation was 2.50% in observation group, which was significantly lower than that in the control group(10.53%), and the difference was statistically significant(P<0.05). Conclusion Remifentanil-propofol by target controlled infusion to maintain anesthesia can maintain stability of hemodynamics of children undergoing tonsillectomy, and shorten the recovery time, which is safe and effective.
Objective To explore application effect of remifentanil-propofol by target controlled infusion(TCI) to maintain anesthesia of children undergoing tonsillectomy and their effect on perioperative hemodynamics. Methods Seventy-eight children with tonsil hypertrophy undergoing tonsillectomy in our hospital from February 2016 to June 2017 were selected as the objects, and then divided into observation group(n=40) and control group(n=38) according to random number table. In the control group, anesthesia was induced with propofol and fentanyl, and maintained with isoflurane inhalation, while the observation group was given remifentanil-propofol by TCI to maintain anesthesia. Hemodynamic parameters [mean arterial pressure(MAP) and heart rate(HR)] at different time points during the perioperative period were compared between the two groups. After operation, the time of spontaneous breathing recovery, eye opening time, extubation time, and time to discharge from the recovery room were compared. Agitation score and Ramsay sedation score in both groups were compared immediately after extubation, 10 min after extubation and when discharged from the recovery room. In addition, postoperative adverse reactions were recorded. Results There was no significant difference in MAP and HR before operation, 1 min after intubation and after regaining consciousness between the two groups(P>0.05). The MAP and HR levels were significantly lower in observation group at the time when mouse gag was placed, when the tonsils were removed, and when extubation was performed, as compared with those in control group(P<0.05). After operation, the time of spontaneous breathing recovery, eye opening time, extubation time, and time to discharge from the recovery room were significantly shortened in observation group than in control group, suggesting significant differences(P<0.05, P<0.01). Agitation scores in observation group were significantly lower than those in the control group immediately after extubation, 10 min after extubation and time to discharge from the recovery room(P<0.05), and Ramsay sedation scores were significantly higher than those in the control group(P<0.05). The incidence of total adverse reactions after operation was 2.50% in observation group, which was significantly lower than that in the control group(10.53%), and the difference was statistically significant(P<0.05). Conclusion Remifentanil-propofol by target controlled infusion to maintain anesthesia can maintain stability of hemodynamics of children undergoing tonsillectomy, and shorten the recovery time, which is safe and effective.
引文
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[2] 蔡小丽,何春华,吴艳.不同剂量右美托咪定用于预防学龄前儿童扁桃体摘除术后躁动的安全性评估[J].重庆医学,2013,42(12):1403-1405.
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[10] 陈晨,李璐,陈子墨.不同血浆靶浓度瑞芬太尼复合异丙酚靶控输注对后腹腔镜手术患者血流动力学的影响[J].中国全科医学,2013,16(23):2161-2164.
[11] 邵伟栋,张兴安,刘礼胜,等.靶控输注丙泊酚复合舒芬太尼或瑞芬太尼用于肾移植手术的临床研究[J].实用医学杂志,2013,29(20):3331-3333.
[12] Cowley N J, Hutton P, Clutton-Brock T H. Assessment of the performance of the Marsh model in effect site mode for target controlled infusion of propofol during the maintenance phase of general anaesthesia in an unselected population of neurosurgical patients[J].Eur J Anaesthesiol, 2013,30(10):627-632.
[13] 兰海涛.异丙酚与镇吐[J].中国临床药理学与治疗学杂志,1999,4(2):125-128.
[14] 强瑞华,张京硕,卢滨俐.瑞芬太尼应用于婴儿麻醉的临床研究[J].中国医药,2010,5(9):852-853.
[15] 高琳琳,李国福,吉凯强.骶管阻滞复合瑞芬太尼静脉输注在小儿麻醉中的应用[J].中国小儿急救医学,2009,16(2):192-193.
[16] 陈宏志,李璐,陈卫民.瑞芬太尼复合丙泊酚麻醉在小儿气管异物取出术中的应用[J].中国小儿急救医学,2007,14(3):218-220.
[17] 薄智,杨常保,李军平.瑞芬太尼复合丙泊酚全身麻醉对小儿扁桃体及腺样体切除术的效果观察[J].吉林医学,2013,34(17):3346-3347.
[18] 夏祖伟,朱长江,曾令全,等.瑞芬太尼复合异丙酚在小儿短小手术麻醉中的临床观察[J].重庆医学,2009,38(6):683-684.
[2] 蔡小丽,何春华,吴艳.不同剂量右美托咪定用于预防学龄前儿童扁桃体摘除术后躁动的安全性评估[J].重庆医学,2013,42(12):1403-1405.
[3] 韦凤妍.扁桃体切除术在不同麻醉方法下的临床比较[J].右江民族医学院学报,2014,36(1):31-32.
[4] 陈铁军,王艳华.瑞芬太尼复合异丙酚在小儿等离子扁桃体腺样体切除术中的应用[J].中国现代医药杂志,2013,15(2):46-48.
[5] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:113-116.
[6] 丁涛,曲月星,徐海霞,等.丙泊酚联合七氟烷复合麻醉对小儿麻醉苏醒期躁动评分的影响[J].现代生物医学进展,2016,16(26):5103-5105.
[7] 王春晓,季文进,马武华.镇静评分是术后椎管内吗啡镇痛呼吸抑制的可靠指标[J].中国疼痛医学杂志,1999(2):12-15.
[8] 朱宏.七氟醚和氯胺酮用于小儿扁桃体摘除术麻醉诱导的比较[J].实用药物与临床,2012,15(12):844-845.
[9] 刘海健,翁浩,王建光.右美托咪定对扁桃体摘除术麻醉苏醒期躁动的影响[J].临床麻醉学杂志,2012,28(8):772-774.
[10] 陈晨,李璐,陈子墨.不同血浆靶浓度瑞芬太尼复合异丙酚靶控输注对后腹腔镜手术患者血流动力学的影响[J].中国全科医学,2013,16(23):2161-2164.
[11] 邵伟栋,张兴安,刘礼胜,等.靶控输注丙泊酚复合舒芬太尼或瑞芬太尼用于肾移植手术的临床研究[J].实用医学杂志,2013,29(20):3331-3333.
[12] Cowley N J, Hutton P, Clutton-Brock T H. Assessment of the performance of the Marsh model in effect site mode for target controlled infusion of propofol during the maintenance phase of general anaesthesia in an unselected population of neurosurgical patients[J].Eur J Anaesthesiol, 2013,30(10):627-632.
[13] 兰海涛.异丙酚与镇吐[J].中国临床药理学与治疗学杂志,1999,4(2):125-128.
[14] 强瑞华,张京硕,卢滨俐.瑞芬太尼应用于婴儿麻醉的临床研究[J].中国医药,2010,5(9):852-853.
[15] 高琳琳,李国福,吉凯强.骶管阻滞复合瑞芬太尼静脉输注在小儿麻醉中的应用[J].中国小儿急救医学,2009,16(2):192-193.
[16] 陈宏志,李璐,陈卫民.瑞芬太尼复合丙泊酚麻醉在小儿气管异物取出术中的应用[J].中国小儿急救医学,2007,14(3):218-220.
[17] 薄智,杨常保,李军平.瑞芬太尼复合丙泊酚全身麻醉对小儿扁桃体及腺样体切除术的效果观察[J].吉林医学,2013,34(17):3346-3347.
[18] 夏祖伟,朱长江,曾令全,等.瑞芬太尼复合异丙酚在小儿短小手术麻醉中的临床观察[J].重庆医学,2009,38(6):683-684.