靶控输注不同浓度瑞芬太尼复合七氟醚用于小儿泌尿外科手术的临床观察

详细信息    查看全文 | 推荐本文 |

英文篇名：Clinical observation of target-controlled infusion of remifentanil combined with sevoflurane in pediatric urological surgery 作者：夏璇 ; 徐波 ; 王竹梅 英文作者：XIA Xuan;XU Bo;WANG Zhu-mei;Department of Anesthesia, Stomatological Hospital of Southern Medical University (Guangdong Stomatological Hospital); 关键词：瑞芬太尼 ; 靶控输注 ; 七氟醚 ; 小儿泌尿外科手术 ; 术后躁动 英文关键词：Remifentanil;;Target-controlled infusion;;Sevoflurane;;Pediatric urological surgery;;Postoperative agitation 中文刊名：ZWYY 英文刊名：Chinese Journal of Modern Drug Application 机构：南方医科大学口腔医院(广东省口腔医院)麻醉科;广州军区广州总医院麻醉科;贵州医科大学附属医院麻醉科; 出版日期：2019-01-25 出版单位：中国现代药物应用 年：2019 期：v.13 基金：基于知识规则的战创伤现场救治多通道靶控联合用药系统研发(项目编号:CWH17J024) 语种：中文; 页：ZWYY201902005 页数：3 CN：02 ISSN：11-5581/R 分类号：13-15

摘要

目的观察靶控输注不同浓度瑞芬太尼复合七氟醚用于小儿泌尿外科手术的临床效果。方法 60例全身麻醉下择期行泌尿外科短小手术的患儿,随机分为RⅠ组、RⅡ组、RⅢ组,每组20例。RⅠ组、RⅡ组、RⅢ组术中靶控输注瑞芬太尼浓度分别为为2.0、2.5、3.0 ng/ml,三组均复合吸入七氟醚维持麻醉,比较三组术毕自主呼吸恢复时间、拔除喉罩时间、苏醒时间、苏醒期躁动情况、拔喉罩后5 min躁动评分、送恢复室后10 min躁动评分及不良反应发生情况。结果三组患儿自主呼吸恢复时间、拔除喉罩时间、苏醒时间及送恢复室后10 min躁动评分比较差异无统计学意义(P>0.05);RⅢ组苏醒期躁动发生率为75%,高于RⅠ组的35%和RⅡ组的10%,差异有统计学意义(P<0.05);RⅢ组拔喉罩后5 min躁动评分为(2.9±0.7)分,高于RⅠ组的(2.0±0.9)分和RⅡ组的(2.0±0.6)分,差异有统计学意义(P<0.05)。三组患儿术后均无喉痉挛、呼吸抑制、恶心呕吐、嗜睡、低氧血症等不良反应发生。结论 2.5 ng/ml瑞芬太尼靶控输注复合2.5%七氟烷是小儿泌尿外科短小手术麻醉维持较为理想的组合。
        Objective To observe the clinical effect of target-controlled infusion of remifentanil combined with sevoflurane in pediatric urological surgery. Methods A total of 60 children with elective urologic short surgery under general anesthesia were randomly divided into RⅠ group, RⅡ group, RⅢ group, with 20 cases in each group. RⅠ, RⅡ and RⅢgroup received target-controlled infusion of remifentanil 2.0, 2.5 and 3.0 ng/ml. Compound inhalation of sevoflurane maintained anesthesia in all three groups. Comparison were made on recovery time of spontaneous breathing, removal time of laryngeal mask, recovery time, restlessness during recovery period, restlessness score 5 minutes after removal of laryngeal mask, restlessness score 10 minutes after delivery to recovery room, and occurrence of adverse reactions were compared in three groups. Results There was no statistically significant difference in recovery time of spontaneous breathing, removal time of laryngeal mask, recovery time, restlessness score 10 minutes after delivery to recovery room(P>0.05). RⅢ group had higher restlessness rate during recovery period as 75% than 35% in RⅠ group and 10% in RⅡ group, and their difference was statistically significant(P<0.05). RⅢ group had higher restlessness score 5 minutes after removal of laryngeal mask as(2.9±0.7) points than(2.0±0.9) points in RⅠ group and(2.0±0.6) points in RⅡ group, and the difference was statistically significant(P<0.05). No adverse reactions such as laryngeal spasm, respiratory depression, nausea and vomiting, sleepiness and hypoxemia occurred in the three groups. Conclusion 2.5 ng/ml remifentanil target-controlled infusion combined with 2.5% sevoflurane is an ideal combination for short-term anesthesia maintenance in pediatric urology.

引文

[1]张悦,冷玉芳,田金徽,等.喉罩与气管插管在小儿全身麻醉气道管理中价值的Meta分析.中国循证医学杂志,2011,11(9):1047-1053.
    [2]王东披,胡瑶琴,胡智勇.七氟醚吸入麻醉在小儿短小手术中的应用.临床麻醉学杂志,2007,23(6):511-512.
    [3]刘秀芬,吴新民.瑞芬太尼靶控输注在小儿眼斜视矫正术中的应用.中国新药杂志,2007(12):967-971.
    [4]雷蕾,康伟,翁小玲,等.右旋美托咪定滴鼻用于小儿腭裂整复术麻醉中的临床研究.口腔疾病防治,2015,23(3):147-151.
    [5]Mingo OH,Ashpole KJ,Irving CJ,et al.Remifentanil sedation for awake fibreoptic intubation with limited application of local anaesthetic in patients for elective head and neck surgery.Anaesthesia,2008,63(10):1065-1069.
    [6]何洹,施冲.靶控输注瑞芬太尼对Narcotrend脑电监测的影响.广东医学,2008,29(10):1708-1709.
    [7]Moerman AT,Herregods LL,De Vos MM,et al.Manual versus targetcontrolled infusion remifentanil administration in spontaneously reathing patients.Anesth Analg,2009,108(3):828-834.
    [8]苏声线,张志刚,李斌飞,等.七氟醚麻醉下瑞芬太尼抑制小儿切皮反应的血浆靶浓度临床分析.当代医学,2012,18(5):1-2.
    [9]刘徐,宋杰,狄伟文.布托啡诺对瑞芬太尼麻醉后痛觉过敏的预防.临床麻醉学杂志,2012,28(3):298-299.