丙泊酚联合不同剂量瑞芬太尼麻醉诱导在小儿喉罩置入中的应用

摘要

目的 探讨丙泊酚联合不同剂量瑞芬太尼麻醉诱导在小儿喉罩置入中的应用效果.方法 选取2015年1月至2017年4月在西宁市第三人民医院接受外科手术治疗的患儿169例,根据瑞芬太尼使用剂量将所有患儿分为A组(56例)、B组(58例)、C组(55例).患儿麻醉诱导进入镇定状态后,A、B、C组分别静脉注射1.0、2.0、3.0 μg/kg瑞芬太尼,再静脉输注2.0 mg/kg丙泊酚.比较3组患儿麻醉开始前(T1)、术中(T2)、术毕清醒时(T3)、清醒后10 rmin(T4)4个时点的收缩压、舒张压、心率、呼吸频率和血氧饱和度,麻醉起效时间、意识恢复时间,术后切口疼痛情况及插管情况,Ramsay镇静评分,警觉/镇静观察评分法(OAA/S)评分,术中和术后6h内不良反应发生情况.结果 B、C组T2时点心率、呼吸频率及C组T3时点心率均明显低于A组(均P＜0.05).3组患儿不同时点收缩压、舒张压、血氧饱和度及麻醉起效时间和一次插管成功、重置插管成功、改气管插管比例比较,差异均无统计学意义(均P ＞0.05).A、B组患儿意识恢复时间、Ramsay镇静评分及OAA/S评分比较,差异均无统计学意义(均P＞0.05),C组患儿意识恢复时间明显长于A组[(5.6±0.7) min比(4.9±0.6) min],术后切口疼痛评分明显低于A组[(5.0±0.7)分比(5.9±0.5)分],Ramsay镇静评分及OAA/S评分明显高于A组[(3.2±0.5)分比(2.9±0.4)分、(5.26±0.39)分比(4.56±0.27)分](均P＜0.05).术中,B、C组患儿体动发生率低于A 组[0.0％ (0/58)、0.0％ (0/55)比3.6％(2/56)],C组患儿呼吸抑制及恶心、呕吐发生率高于A组[12.7％(7/55)比5.4％(3/56)、10.9％ (6/55)比3.6％(2/56)](均P＜0.05).术后6h,C组患儿恶心、呕吐及躁动发生率高于A组[21.8％(12/55)比8.9％ (5/56)、14.5％(8/55)比5.4％ (3/56)](均P＜0.05).结论 1.0μg/kg瑞芬太尼复合丙泊酚对小儿喉罩置入进行麻醉诱导具有良好的麻醉效果,且安全性较高.%Objective To analyze the effect of propofol combined with different doses of remifentanil anesthesia induction on children receiving laryngeal mask airway placement.Methods Totally 169 children undergoing surgical treatment in the Third People's Hospital of Xining from January 2015 to April 2017 were divided into group A (n =56),group B (n =58) and group C (n =55).Patients in group A,B,C had 1.0,2.0,3.0 μg/kg remifentanil and 2.0 mg/kg propofol.Systolic blood pressure,diastolic blood pressure,heart rate,respiratory rate and blood oxygen saturation were measured before anesthesia(T1),during operation (T2),at the end of operation(T3) and 10 min after awakening(T4).Anesthesia onset time,consciousness recover time,incision pain score,intubation condition,Ramsay sedation score,Observer Assessment of Alertness/Sedation (OAA/S) score,intraoperative and postoperative 6 h adverse events were analyzed.Results Heart rate and respiratory rate at T2 in group B and heart rate at T3 in group C were significantly lower than those in group A [(94 t±10),(94 ± 10)times/min vs (97 ± 10)times/min;(11.4±1.4),(10.1 ±2.1) times/ min vs (13.6 ± 2.1)times/min;(101 ± 12) times/min vs (105 ± 14) times/ min] (P ＜ 0.05).There were no significant differences of systolic blood pressure,diastolic blood pressure,blood oxygen saturation,anesthesia onset time,primary intubation success rate,secondary intubation success rate and tracheal intubation rate among groups (P ＞ 0.05).Consciousness recovery time,Ramsay sedation scoreand OAA/S score had no significant differences between group A and B (P ＞ 0.05);consciousness recovery time in group C was significantly longer than that in group A [(5.6 ± 0.7)min vs(4.9 ± 0.6) min];incision pain score in group C was significantly lower than that in group A [(5.0 ± 0.7) points vs (5.9 ± 0.5) points];Ramsay sedation score and OAA/S score in group C were significantly higher than those in group A [(3.2 ± 0.5) points vs (2.9 ± 0.4) points,(5.26 ± 0.39) points vs (4.56 ± 0.27) points] (P ＜ 0.05).Incidence of intraoperative body movement in group B and C was significantly lower than that in group A [0.0％ (0/58),0.0％ (0/55) vs 3.6％ (2/56)];incidences of intraoperative respiratory depression,nausea and vomiting in group C were significantly higher than those in group A [12.7％ (7/55) vs 5.4％ (3/56),10.9％ (6/55) vs 3.6％ (2/56)] (P ＜ 0.05).Incidences of postoperative 6 h nausea and vomiting,agitation in group C were significantly higher than those in group A[21.8％ (12/55) vs 8.9％ (5/56),14.5％(8/55) vs5.4％(3/56)](P＜0.05).Conclusion Anesthesia induction using remifentanil 1.0 μg/kg combined with propofol has good anesthetic effect and safety in children receiving laryngeal mask airway placement.