摘要
目的观察瑞芬太尼复合异丙酚靶控输注（TCI）应用于幼儿癫痫手术的麻醉效果。方法选择顽固性癫痫手术患儿30例，随机分为观察组（A组，n=15）和对照组（B组，n=15），A组采用瑞芬太尼复合异丙酚TCI维持，靶控血药浓度分别为2．5ng／mL和2．5ug／mL,,B组吸入1％～2％异氟烷和输注异丙酚2mg·kg^-1·h^-1维持。监测术中生命体征，记录可检测到皮层脑电图（ECoG）的时间、自主呼吸恢复时间和苏醒至能呼之睁眼的时间，观察术后恶心、呕吐和烦躁等不良反应。结果两组术中循环功能相对稳定，B组平均动脉压（MAP）和心率（HR）在切皮后2min显著升高，与A组相比差异有统计学意义（P〈0．05）。两组患儿清醒时MAP和HR均较切皮前显著升高，差异有统计学意义（P〈0．05）。A组ECoG可检测时间、自主呼吸恢复时间和术毕清醒时间均较B组缩短，两组比较差异有统计学意义（P〈0．05）。A组的恶心、呕吐发生率较B组低。结论瑞芬太尼复合异丙酚TCI的静脉麻醉是幼儿癫痫手术较为理想的麻醉方案，能做到术中麻醉平稳，快速的ECoG检测，术后清醒完全迅速。若患儿清醒后需要保留气管导管，应考虑给予适当的镇静和镇痛。
Objective To observe the anesthetic effects of remifentanil-propofol target controlled infusion（TCI）for epileptic surgery in infants. Methods Thirty infants （aged 1--3 years,ASA Ⅰ-- Ⅱ ） scheduled for epileptic surgery were randomly assigned to receive remifentanil-propofol TCI intravenous anesthesia （group A,n= 15） and isoflurane combined propofol anesthesia（group B,n = 15）. After standard induction of anesthesia in both groups,anesthesia in group A was maintained with target-controlled infusion of remifentanil and propofol, the required target-controlled blood concentration was set to 2.5ng/mL and 2.5ug/mL respectively, while anesthesia in group B was maintained with l %--2% isoflurane and intravenous propofol 2mg·kg^-1·h^-1. Invasive blood pressure, HR,SpO2 and ECG were monitored during anesthesia. The time of detectable electrocorticography, pontaneous breathing recovery and eye opening were recorded,and the incidences of agitation,nausea and vomiting were abserved after operation. Results Both anesthesia methods resulted in stable hemodynamics,but the HR and MAP in group B were significantly higher than those in group A at 2 minutes after skin incision, P〈0.05; The time of detectable electrocorticography, pontaneous breathing recovery and eye opening in group A was significantly shorter than those in group B, P〈0. 05. Less incidence of nausea and vomiting was abserved after operation in group A than in group B. Conclusion Intravenous anesthesia with remifentanil-propofol TCI is better than isoflurane-propofol anesthesia for epileptic surgery in infants. It could keep anesthesia smoothly, speed up electrocorticography detecting and make patients recover from anesthesia more quickly and completely. If the operated infants will leave operating room without extubation,proper sedatives and analgesics should be given.
出处
《重庆医学》
CAS
CSCD
2008年第17期1922-1924,共3页
Chongqing medicine
关键词
异丙酚
瑞芬太尼
靶控输注
幼儿
癫痫手术
麻醉
propofol
remifentanil
target controlled infusion
infant
epileptic surgery
anesthesia
