瑞芬太尼-丙泊酚联合靶控输注在小儿喉罩麻醉中的应用被引量：6

Application of target controlled infusion for remifentanil plus propofol in pediatric surgery with laryngeal mask airway anesthesia

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摘要目的探讨瑞芬太尼联合丙泊酚联合靶控输注在小儿喉罩麻醉中应用的安全性和可行性。方法选择择期全麻下行腹部手术患儿116例,随机分为瑞芬太尼联合丙泊酚组（A组）和单纯丙泊酚组（B组）,每组58例。两组患儿分别静脉输注瑞芬太尼1μg/kg和等容量生理盐水30 s后静注丙泊酚,按照序贯法给予患儿相应的丙泊酚剂量,丙泊酚靶浓度为2.5 mg/kg,后行喉罩插入。观察并记录麻醉诱导前（T0）、瑞芬太尼给药后2 min（T1）、喉罩成功插入即刻（T2）、切皮即刻（T3）、切皮后5 min（T4）和喉罩拔出即刻（T5）患儿的血压（HR）、平均动脉压（MAP）、呼气末二氧化碳分压（PETCO2）和脑电双频谱指数（BIS）以及记录喉罩重新置入的人数、置入时间、术中不良反应。结果与T0时刻比较,B组患儿的HR、MAP在T2、T3、T5时刻均升高（P〈0.01）,而A组患儿在各时点HR、MAP差异无统计学意义（P〉0.05）。与B组患儿比较,A组患儿的HR、MAP在T2、T3、T5时刻降低（P〈0.01）。两组患儿PETCO2在T1、T2、T3、T4时刻均高于T0（P〈0.01）。与A组患儿比较,B组患儿BIS在T1～T5时刻均升高（P〈0.01）,两组患儿在T1-T5时刻BIS均低于T0（P〈0.01）。A组的患儿喉罩插入后出现咳嗽/作呕、肢体动的例数少于B组（P〈0.05）。结论瑞芬太尼联合丙泊酚靶控输注的麻醉诱导方法能够为患儿喉罩插入提供较好的麻醉条件和较低的不良反应发生率。 Objective To study the feasibility and safety of target controlled infusion for remifentanil plus propofol in pediatric surgery with laryngeal mask airway anesthesia. Methods A total of 116 pediatric patients under- went elective abdominal surgery were randomly divided into two groups （58 cases in each group）： remifentanil plus propofol group （group A） and propofol plus saline group （group B）. Thirty seconds after the injection of 1 lag/kg remi- fentanil or saline, propofol was given i.v. followed by insertion of laryngeal mask 90 s. The initial target plasma con- centrations of propofol were 2.5 mg/kg. HR, MAP, PETCO2 and BIS were recorded before anesthesia induction （T0）, 2 min after remifentanil treatment （T1）, at the time of inserting laryngeal mask successfully （T2） and cutting the skin （T3）, 5 min after cutting the skin （T4）, as well as at the time of pulling out laryngeal mask （T5）. The number of reinsert of laryngeal mask, insert time and adverse events were also recorded. Results Both HR, MAP increased at T2, T3,T5 in group B compared with To （P〈0.05）, but there was no difference of HR, MAP in group B at different times （P〉0.05）. Compared with group B, HR, MAP decreased in group A at T2, T3, T5 （P〈0.05）. Both groups of PErCO2 at T1, T2, T3, T4 were higher than at To （P〈0.05）. Compared with group A, BIS in group B increased at T1-T5 （P〈0.05） and BIS in two groups at T1-T5 were lower than To （P〈0.05）. There were more adverse reactions （coughing, vomiting, arm and hand movements） in group B than group A （P〈0.05）. Conclusion Target controlled infusion for remifentanil plus propo- fol can provide better condition of laryngeal mask airway anesthesia in pediatric patients with low incidence of ad- verse reactions.