摘要
目的观察瑞芬太尼快速通道麻醉对先天性心脏病介入封堵术患儿麻醉恢复质量的影响。方法先天性心脏病患儿均进行介入封堵术。根据患儿麻醉方案分为试验组和对照组。对照组麻醉诱导:肌内注射氯胺酮4 mg·kg^(-1),静脉注射丙泊酚2.5 mg·kg^(-1)、芬太尼10μg·kg^(-1)、顺阿曲库铵0.1 mg·kg^(-1),麻醉维持:芬太尼0.4μg·kg^(-1)·min^(-1)、丙泊酚8μg·kg^(-1)·min^(-1)。试验组麻醉诱导:肌内注射氯胺酮5 mg·kg^(-1),静脉注射咪达唑仑0.1 mg·kg^(-1),舒芬太尼1.0μg·kg^(-1)、顺阿曲库铵0.1 mg·kg^(-1),麻醉维持:瑞芬太尼0.5μg·kg^(-1)·min^(-1)、丙泊酚8μg·kg^(-1)·min^(-1)。比较2组麻醉苏醒情况、面部表情-腿部姿势-活动-哭闹-可安慰性(FLACC)5项疼痛评分、Ramsay评分、血流动力学指标、心肌损伤指标和药物不良反应发生情况。结果试验组64例和对照组56组。试验组患儿的自主呼吸恢复时间、呼叫睁眼时间、拔管时间分别为(4.87±1.22)、(10.16±2.58)和(12.55±3.19)min,均显著短于对照组的(5.49±1.35)、(13.34±3.27)和(15.67±3.62)min(均P<0.05)。术后1、2 h,试验组患儿的Ramsay评分为(2.58±0.35)和(3.69±0.42)分,均显著低于对照组的(3.02±0.47)和(4.24±0.39)分(均P<0.05)。术后1、2 h,试验组患儿的FLACC评分为(3.03±0.81)和(3.75±0.84)分,均显著低于对照组的(3.78±0.62)和(4.36±0.51)分(均P<0.05)。喉罩置入时、封堵器置入时、术毕,试验组的平均动脉压(MAP)为(102.45±10.26)、(94.18±8.37)和(91.46±10.15)mmHg,均显著低于对照组的(107.84±10.11)、(100.57±9.84)和(97.33±8.53)mmHg(均P<0.05)。术后1 d、术后3 d,试验组的血清肌酸激酶同工酶(CK-MB)水平为(10.03±2.58)和(8.65±2.16)U·L^(-1),均显著低于对照组的(12.44±3.07)和(10.16±2.35)U·L^(-1)(均P<0.05)。术后1 d、术后3 d,试验组的血清心肌肌钙蛋白Ⅰ(cTnⅠ)水平为(0.07±0.02)和(0.04±0.01)μg·L^(-1),均显著低于对照组的(0.09±0.03)
Objective To observe the effect of remifentanil-based fast-track anesthesia on the quality of anesthesia recovery in children with congenital heart disease underwent transcatheter closure.Methods Children with congenital heart disease who underwent transcatheter closure were divided into treatment group and control group according to the anesthesia plan.The anesthesia plan of the control group was as follows:anesthesia induction (intramuscular injection of ketamine at 4 mg·kg^(-1),intravenous injection of propofol at 2.5 mg·kg^(-1),fentanyl at 10μg·kg^(-1)and cisatracurium at 0.1 mg·kg^(-1)) and anesthesia maintenance (fentanyl at 0.4μg·kg^(-1)·min^(-1)and propofol at 8μg·kg^(-1)·min^(-1)).The anesthesia plan of the treatment group was as follows:anesthesia induction (intramuscular injection of ketamine at 5 mg·kg^(-1),intravenous injection of midazolam at 0.1 mg·kg^(-1),sufentanil at 1.0μg·kg^(-1)and cisatracurium at 0.1 mg·kg^(-1)) and anesthesia maintenance (remifentanil at 0.5μg·kg^(-1)·min^(-1)and propofol at 8μg·kg^(-1)·min^(-1)).Anesthesia recovery,facial expression,leg posture,activity,crying and comfortability (FLACC) of 5 pain scores,Ramsay score,hemodynamics,myocardial injury indexes,and adverse drug reactions were compared between the two groups.Results There were 64 cases in treatment group and 56 cases in control group.The spontaneous respiration recovery time,call time and extubation time of the treatment group were (4.87±1.22),(10.16±2.58) and (12.55±3.19) min,shorter than those in control group,which were (5.49±1.35),(13.34±3.27) and (15.67±3.62) min (all P<0.05).At 1 h and 2 h after operation,Ramsay scores of treatment group were 2.58±0.35 and 3.69±0.42,were lower than 3.02±0.47 and 4.24±0.39 in control group (all P<0.05).At 1 h and 2 h after operation,the FLACC scores of the treatment group were 3.03±0.81 and 3.75±0.84,lower than 3.78±0.62 and 4.36±0.51 in control group (all P<0.05).Mean arterial pressure (MAP) of treatment group at the insertion of laryngeal
作者
景海娟
林洪启
王海丽
秦鹏宇
慎晓飞
吕品
JING Hai-juan;LIN Hong-qi;WANG Hai-li;QIN Peng-yu;SHEN Xiao-fei;LÜPin(Department of Anesthesiology,Fuwai Central China Cardiovasculer Hospital,Heart Center of Henan Provincial People’s Hospital,Zhengzhou 451464,Henan Province,China;Department of Anesthesiology,Sanmenxia Central Hospital,Sanmenxia 472000,Henan Province,China)
出处
《中国临床药理学杂志》
CAS
CSCD
北大核心
2024年第3期340-344,共5页
The Chinese Journal of Clinical Pharmacology
关键词
瑞芬太尼
快速通道麻醉
先天性心脏病
介入封堵术
remifentanil
fast-track anesthesia
congenital heart disease
transcatheter closure
