摘要
目的观察无肌松药情况下雷米芬太尼、丙泊酚复合七氟烷用于小儿腺样体、扁桃体切除术中的临床效果。方法选择2015年7月至2017年8月在医院小儿外科行腺样体及扁桃体切除术的患儿84例,随机分为无肌松药麻醉组(观察组,48例)和维库溴铵肌松药麻醉组(对照组,36例)。静脉注射丙泊酚1 mg/kg,雷米芬太尼1.0～1.5μg/kg,地塞米松1.0～1.5μg/kg,待意识消失后,给予面罩加压给氧,对照组患儿给予肌松药维库溴铵0.1 mg/kg,90 s后辅助气管插管;观察组患儿经面罩吸入纯氧(4 L/min)+8%七氟烷2 min后行气管插管。持续静脉注射丙泊酚和瑞芬太尼,吸入1%七氟烷以维持麻醉。监测并记录患儿麻醉诱导前(t0)、气管插管前即刻(t_1)、气管插管后3 min(t_2)、气管插管后5 min(t_3)及拔除气管导管即刻(t_4)患儿的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2);记录患儿睫毛反射消失、疼痛反应消失、苏醒及拔管时间,以及术后并发症发生情况。结果观察组患儿睫毛反射消失时间、疼痛反应消失时间、手术时间、术后苏醒时间和拔管时间均短于对照组患儿(P<0.05);观察组患儿插管满意度为100.00%,高于对照组患儿的91.67%(P<0.05);在t_1,t_2,t_3时点,两组患儿MAP,SpO_2,HR水平均低于t0基础水平(P<0.05),且对照组患儿SpO_2和HR水平均低于观察组患儿(P<0.05);对照组患儿术后剧烈呛咳、术后躁动和无恶心呕吐的发生率明显高于观察组患儿(P<0.05)。结论无肌松药情况下雷米芬太尼、丙泊酚联合七氟烷麻醉用于小儿腺样体及扁桃体切除术安全有效,麻醉诱导平稳,插管条件良好。
Objective To observe the clinical effect of general anesthesia induction with remifentanil, propofol and sevoflurane without muscle relaxant in children patients undergoing tonsillectomy and adenoidectomy. Methods Totally 84 children undergoing tonsillectomy and adenoidectomy in our hospital from July 2015 to August 2017 were selected and divided into the observation group（ n =48,without muscle relaxant） and the control group（ n =36,treated with vecuronium bromide）. All patients were intravenously injected with propofol 1 mg/kg, remifentanil 1.0 - 1.5 μg/kg, dexamethasone 1.0 - 1.5 μg/kg, the mask was given to pressurize oxygen after the patients＇ consciousness disappeared. The control group was given the muscle relaxant vecuronium 0.1 mg/kg,and the tracheal intubation was assisted after 90 s. The observation group was intubated after inhaling pure oxygen 4 L/min ＋ 8% sevofluane for 2 min through mask. Continuous intravenous infusion of propofol and remifentanil,inhalation of 1% sevoflurane to maintain anesthesia. The values of the patients＇ heart rate（HR）,mean arterial pressure（MAP）,and pulse oxygen （t0）,immediately before intuhation（t1）,at 3 rain after intuhations（t2）,at 5 saturation（SpOt） were recorded before induction of anesthesia min after intubations（t3）,and immediately after extubation（t4）. The eyelash reflex disappearance time,pain response disappearance time,recovery time and extubation time,and postoperative complications were recorded. Results The eyelash reflex disappearance time,pain response disappearance time, surgery time,postoperative recovery time,excubation time in the observation group were shorter than those in the control group（P 〈 0.05）. The satisfaction rate of intubation in the observation group was 100.00% ,which was higher than 91.67% in the control group（P 〈 0. 05）. The levels of MAP,SpOe and HR in the two groups at tl,t2,t3 were lower than the baseline at t0（P 〈 0.05）,and the levels of SpO2 and HR in the control group
作者
蔚波
汪涛
李玲
夏勇
Yu Bo;Wang Tao;Li Ling;Xia Yong(Wuhan Red Cross Hospital,Wuhan,Hubei,China 430015;Ezhou Hospital of Traditional Chinese Medicine,Ezhou,Hubei,China 436000;Ezhou Maternal and Child Health Hospital,Ezhou,Hubei,China 436000)
出处
《中国药业》
CAS
2018年第18期52-55,共4页
China Pharmaceuticals
关键词
全身麻醉
小儿
无肌松药麻醉
七氟烷
腺样体切除术
扁桃体切除术
general anesthesia
children patients
anesthesia without muscle relaxant
sevoflurane
tonsillectomy
adenoidectomy
