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目的比较瑞芬太尼复合丙泊酚全凭静脉全身麻醉和瑞芬太尼复合七氟烷静脉吸入复合全身麻醉在低龄小儿腹腔镜下疝囊高位结扎手术中的临床应用。方法将60例行择期腹腔镜下疝囊高位结扎手术的低龄(7～30个月)患儿按信封法随机分入瑞芬太尼复合丙泊酚全凭静脉全身麻醉组(全凭静脉组)和瑞芬太尼复合七氟烷静脉吸入复合全身麻醉组(静脉吸入复合组),每组30例。记录两组的手术时间和麻醉时间,麻醉诱导和维持期间的平均动脉压(MAP)、心率(HR)和脑电双频指数(BIS)值,麻醉诱导时间、停药后拔除气管导管的时间(拔管时间)、苏醒时间,以及拔除气管导管后苏醒期间烦躁和其他并发症发生率。结果两组间麻醉诱导和维持期间各时间点MAP、HR和BIS值的差异均无统计学意义(P值均>0.05)。两组间手术时间、麻醉时间、麻醉诱导时间、拔管时间、苏醒时间的差异均无统计学意义(P值均>0.05)。静脉复合组有17.9%(5/28)的患儿出现拔除气管导管后躁动,显著低于全凭静脉组的56.7%(17/30,P<0.05);两组患儿均未发生术后恶心呕吐、低氧、喉痉挛、舌下坠、咳嗽、呼吸抑制等不良反应。结论七氟烷复合瑞芬太尼静脉吸入复合全身麻醉和丙泊酚复合瑞芬太尼全凭静脉全身麻醉均能为低龄小儿腹腔镜下疝囊高位结扎手术提供快速、安全的麻醉。静脉吸入复合全身麻醉具有更简单、可控的优点,但全凭静脉全身麻醉可为患儿争取更有利的苏醒质量。
Objective To compare the clinical effects of remifentanil combined with propofol total intravenous anesthesia and remifentanil combined with sevoflurane intravenous anesthesia in the treatment of laparoscopic high ligation of hernia sac in young children. Methods A total of 60 young children (7 to 30 months old) who underwent laparoscopic high ligation of hernia sac undergoing elective ligation were randomly divided into remifentanil combined propofol total intravenous anesthesia group ) And remifentanil combined sevoflurane intravenous composite general anesthesia group (intravenous inhalation complex group), 30 cases in each group. The operation time and anesthesia time were recorded in the two groups. Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) during anesthesia induction and maintenance, induction time of anesthesia, (Extubation time), recovery time, and frequency of irritability and other complications during wakefulness after tracheal catheter removal. Results There was no significant difference in MAP, HR and BIS between the two groups during induction and maintenance of anesthesia (P> 0.05). The operation time, anesthesia time, anesthesia induction time, extubation time and recovery time were not significantly different between the two groups (P> 0.05). 17.9% (5/28) of the patients in the intravenous combined group showed restlessness after tracheal extubation, which was significantly lower than 56.7% (17/30, P <0.05) in the total intravenous group; no postoperative Nausea and vomiting, hypoxia, laryngospasm, tongue drop, cough, respiratory depression and other adverse reactions. Conclusion Sevoflurane combined with remifentanil intravenous combined with general anesthesia and propofol combined with remifentanil through total intravenous anesthesia can provide fast and safe anesthesia for laparoscopic high ligation of laparoscopic hernia sac in young children. Intravenous inhalation combined with general anesthesia has the advantages of more simple, controllable, but the whole intravenous anesthesia for children with more favorable wake quality.