不同剂量舒芬太尼与丙泊酚及顺苯磺阿曲库铵联合应用在小儿腹腔镜手术中的效果

摘要

Objective To investigate the effect of three doses of Sufentanil anesthesia in children laparoscopic surgery. Methods From March to November 2014, in Huzhou Central Hospital, 61 children underwent laparoscopic operation were selected and randomly divided into group A, B, C, these groups were given Sufentanil 0.3, 0.4, 0.5 μg/kg respec-tively and combined with Propofol and Cisatracurium Besylate for induction of anesthesia; according to the operation condition, it can be added 0.01 μg/mL Sufentanil. The Sufentanil usage, anesthesia, cardiovascular index changes and adverse reactions of three groups were compared. Results The amount of Sufentanil in group C was significantly higher than that in group B (P<0.05), additional Sufentanil rate of children in group A was significantly higher than those in group B and group C (P<0.05);anesthesia total effective rate in group A, B, C were 61.9%, 85%, 95%; total effective rate in group A was lower than those in group B, C (P< 0.05), those in group B and C were compared, the difference was not statistically significant (P>0.05). After anesthesia, MAP, SBP, DBP, HR in three groups were decreased than the baseline values (P< 0.05); after the surgery, cardiovascular index values of three groups were compared with the baseline values, the differences were not statistically significant (P > 0.05). During the surgery, MAP, SBP, DBP in group were higher than the baseline values, the differences were statistically significant (P< 0.05), HR was compared with the baseline value, the difference was not statistically significant (P>0.05);during the surgery, MAP, SBP, DBP, HR in group B and C were compared with the baseline values, the differences were not statistically significant (P >0.05). With Sufentanil usage increasing, severe limb incidence decreased (P< 0.05); but with Sufentanil usage increa-seing, respiratory depression, bradycardia, hypoxemia incidences did not changed obviously (P> 0.05). Conclusion In children laparoscopic surgery, 0.5 μg/kg Sufentanil usage combine Propofol and Satracurium Besylate has stable hemo-dynamics, less adverse reactions, higher efficiency anesthesia.%目的：探讨三种剂量舒芬太尼在患儿腹腔镜手术中麻醉效果的影响。方法选取2014年3~11月于湖州市中心医院行腹腔镜手术的患儿61例，随机分成A、B、C组，分别给予舒芬太尼0.3、0.4、0.5μg/kg并联合丙泊酚及顺苯磺阿曲库铵进行麻醉诱导；术中根据患儿情况，可追加0.01μg/mL的舒芬太尼。比较各组间舒芬太尼使用情况、麻醉效果、心血管指标变化情况以及不良反应。结果 C组舒芬太尼使用量显著高于B组(P<0.05)，A组患儿舒芬太尼追加率显著高于B组和C组(P<0.05或P<0.01)。A、B、C组的麻醉总有效率为分别为61.9%、85%、95%；A组总有效率明显低于B组和C组(P<0.05)，B组与C组总有效率差异无统计学意义(P>0.05)。三组患儿麻醉后，平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)、心率(HR)与各自基础值比较均显著降低(P<0.05)；术后三组患儿的心血管指标与基础值比较，差异无统计学意义(P>0.05)。 A组的术中患儿的MAP、SBP、DBP与基础值比较均显著升高，差异有统计学意义(P<0.05)，HR值与基础值比较，差异无统计学意义(P>0.05)；术中B组和C组患儿的MAP、SBP、DBP、HR值与基础值比较，差异均无统计学意义(P>0.05)。随着舒芬太尼使用量的增加，肢体反应率逐渐降低(P<0.05)；但随着舒芬太尼使用量的增加，呼吸抑制、心动过缓、低血氧症发生率无明显变化(P>0.05)。结论在患儿腹腔镜手术中，0.5μg/kg舒芬太尼使用量在联合丙泊酚和顺苯磺阿曲库铵行麻醉诱导时能具有稳定的血流动力学，较少的不良反应以及较高的麻醉有效率。