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目的:比较全凭静脉麻醉丙泊酚、瑞芬太尼用于小儿支撑喉镜手术麻醉与静吸复合麻醉对血流动力学的影响及苏醒期特点。方法:选择40例行小儿支撑喉镜手术的患儿,年龄4～12岁,ASAⅠ～Ⅱ级,随机分为全凭静脉麻醉(Ⅰ)组和静吸复合麻醉(Ⅱ)组,每组20例。常规麻醉诱导后,Ⅰ组采用靶控输注丙泊酚、瑞芬太尼维持麻醉,Ⅱ组采用吸入异氟烷及静脉输注丙泊酚维持麻醉。手术结束后立即停止所有药物的输入,记录术中的血压(BP)、心率(HR)、脉搏血氧饱和度(SpO2)和术毕停药后自主呼吸恢复时间、呼之睁眼时间、拔管时间;观察患儿拔管后即刻、1h、3h的意识状态(OAA/S)评分以及术后躁动和恶心呕吐的发生率。结果:Ⅱ组术中的HR较Ⅰ组明显增快,并且苏醒期躁动的发生率也较Ⅰ组高。两组术后自主呼吸恢复时间、睁眼时间、拔管时间差异无显著性,但Ⅰ组拔管后即刻、1h的OAA/S评分高于Ⅱ组。结论:靶控输入丙泊酚、瑞芬太尼用于小儿是一种较好的麻醉方法,与静吸复合麻醉比较术中的HR较低、苏醒质量较优良。
OBJECTIVE: To compare the effects of anesthesia with propofol and remifentanil on hemodynamics and anesthesia during pediatric laryngoscope surgery. Methods: Forty pediatric patients undergoing pediatric laryngoscopy were randomly divided into two groups: total intravenous anesthesia group (Ⅰ) and intravenous combined inhalation anesthesia group (Ⅱ) example. After induction of conventional anesthesia, target-controlled infusion of propofol and remifentanil were used to maintain anesthesia in group I, propofol was inhaled and intravenous infusion of isoflurane was used to maintain anesthesia in group II. All drugs were stopped immediately after the surgery, and intraoperative BP, HR, SpO2 and spontaneous breathing recovery time after surgery were recorded. The time of observation, the status of consciousness (OAA / S) at 1h, 3h immediately after extubation and the incidence of postoperative agitation and nausea and vomiting were observed. Results: HR in group Ⅱ was significantly higher than that in group Ⅰ, and the incidence of restlessness was higher in group Ⅱ than in group Ⅰ. There was no significant difference between the two groups in the recovery time of spontaneous respiration, the time of open eye and the time of extubation. However, the score of OAA / S in group Ⅰ was higher than that in group Ⅱ immediately after extubation. Conclusion: Target controlled infusion of propofol and remifentanil is a good anesthetic method for pediatric patients. Compared with static anesthesia combined with anesthesia, intraoperative HR is lower and recovery quality is better.