不同剂量舒芬太尼在小儿短小手术麻醉诱导中的效果比较

摘要

目的 比较不同剂量舒芬太尼用于小儿短小手术麻醉诱导中的效果和安全性.方法 选择2016年3－10月在广元市第三人民医院行手术的60例患儿作为研究对象,年龄2～7岁,美国麻醉医师协会分级为Ⅰ级,手术时间少于1 h.按随机数字表法分为3组,每组各20例:舒芬太尼0.2 μg/kg组(A组)、舒芬太尼0.3 μg/kg组(B组)、舒芬太尼0.4 μg/kg组(C组).A 、B 、C组分别静脉注射舒芬太尼0.2 、0.3 、0.4 μg/kg,再静脉注射顺阿曲库铵0.1 mg/kg 、丙泊酚1.5 mg/kg麻醉诱导后,插入1.5或2.0号Cookgas喉罩,采用压力控制(PCV)模式行机械通气.记录3组患儿麻醉前(T0)、麻醉诱导后(T1)、插管时(T2)、插管后3 min(T3)各时间点的收缩压(SBP)、舒张压(DBP)、心率(HR)及血氧饱和度(SPO2)值,并记录麻醉时间、手术时间、苏醒时间、拔罩时间及七氟醚总用量,评价患儿苏醒质量.采用小儿苏醒期烦躁量表(PAED)评估躁动程度,记录麻醉期间心血管不良事件和喉痉挛发生情况.结果 与C组比较,A组和B组拔管时间和苏醒时间明显缩短,差异均有统计学意义(P＜0.05);A组和B组在T1 、T2 、T3时SBP明显升高,差异有统计学意义(P＜0.05);与T0时比较,3组患儿在T1 、T2 、T3时SBP 、DBP 、HR明显降低,SPO2明显升高,差异均有统计学意义(P＜0.05);与A组比较,B 、C组七氟醚用量均明显减少,与B组比较,C组七氟醚用量明显减少,差异均有统计学意义(P＜0.05);B组苏醒质量较C组高,差异有统计学意义(P＜0.05);与A组比较,B 、C组PAED评分和躁动发生率均下降,差异均有统计学意义(P＜0.05);C组有2例(10％)发生窦性心动过缓,A组在拔管时有2例(10％)发生喉痉挛.结论 舒芬太尼在小儿短小手术麻醉诱导中镇痛效果确切、不良反应少,其推荐剂量为0.3 μg/kg.%Objective To compare the efficacy and safety of different doses of sufentanil for anesthesia in-duction in pediatric with minor surgery.Methods A total of 60 children who udnerwent caspediatric surgery from March to October 2016 in Guangyuan Third People′s Hospital,aged 2 to 7 years old,grade Ⅰ classified by American Association of Anesthesiologists,with predicted duration of surgery ＜1 h,were randomly divid-ed into three groups with 20 cases in each group by using a random number table method:sufentanil 0.2 μg/kg group(group A),0.3 μg/kg group(group B),0.4 μg/kg group(group C).After intravenous injection of sufentanil in 0.2,0.3,0.4 μg/kg in group A,B and C respectively,the anesthesia induction of intravenous in-jection of 0.1 mg/kg of cisatracurium and 1.5 mg/kg of propofol was performed.The No.1.5 or 2.0 Cookgas laryngeal mask was inserted with PCV model for mechanical ventilation.The the systolic pressure(SBP),di-astolic blood pressure(DBP),heart rate(HR)and saturation(SPO2)values of the three groups were recor-ded before anesthesia(T0),after induction of anesthesia(T1),during intubation(T2)and 3 min after intuba-tion(T3).The time of anesthesia,operation time,recovery time,extubation time and total amount of sevoflu-rane were recorded.The quality of awakening was evaluated.The degree of agitation was assessed using the children′s recovery scale(PAED).The incidence of cardiovascular adverse events and laryngeal spasm during anesthesia were recorded.Results Compared with group C,the extubation time and recovery time of group A and group B significantly shorter,and the difference was statistically significant(P＜ 0.05),and the SBP in T1,T2 and T3 of group A and group B significantly increased,and the difference was statistically significant(P＜0.05).Compared with T0,the SBP,DBP and HR significantly decreased in T1,T2 and T3 of the three groups,SPO2was significantly increased,and the difference was statistically significant(P＜0.05).Compared with group A,the amounts of sevoflurane of group B and group C significantly decreased(P＜ 0.05);com-pared with group B,the amount of sevoflurane of group C was significantly reduced and the difference was sta-tistically significant(P＜0.05).Awakening quality of group B was higher than that of group C(P＜0.05).Compared with group A,the PAED score and the incidence of agitation of group B and group C decreased,and the differences were statistically significant(P＜ 0.05).There were 2 cases of sinus bradycardia(10％)in group C,and 2 cases with laryngeal spasm(10％)in group A.Conclusion The analgesic effect of sufentanil is effective and less side effects for anesthesia induction in pediatric with minor surgery,and the recommended dose is 0.3 μg/kg.