KUANG Ri yu,ZHANG Xi ying,ZHU Shi li,et al.Sevoflurane combined with remifentanil anesthesia for pediatric tracheal microscopic surgery[J].Journal of Clinical Pediatric Surgery,2013,12(03):226-228.[doi:10.3969/j.issn.1671—6353.2013.03.020]
七氟烷复合瑞芬太尼麻醉在小儿气管镜检术中的应用观察
- Title:
- Sevoflurane combined with remifentanil anesthesia for pediatric tracheal microscopic surgery
- Keywords:
- Bronchoscopy; Anesthesia; General; Anesthtics; Child
- 摘要:
- 目的观察七氟烷复合瑞芬太尼用于小儿气管镜检术的麻醉效果；并通过与目前常用麻醉方法的比较，探讨更合适的麻醉方法。方法选择40例需行气管镜检术的患儿，年龄2～5岁，随机分为七氟烷复合瑞芬太尼麻醉组(S组)、氯胺酮、丙泊酚复合小剂量维库溴铵麻醉组(K组)。术中持续监测并记录患儿SpO2、HR、BP及ECG，并观察记录手术时间、苏醒时间、术中喉痉挛和术后恶心、呕吐的发生情况。结果S组麻醉后心率、血压下降，与麻醉前相比，有统计学意义（P<005）。S组麻醉后心率、血压与K组相比较低，差异有统计学意义（P<005）。两组苏醒时间比较，S组较K组短，差异有统计学意义（P<005）。两种麻醉方法，都有满意的肌松效果，声门显露充分，无呛咳、屏气现象。结论七氟烷复合瑞芬太尼麻醉用于小儿气管镜检术，可为手术操作提供满意的肌松条件，声门显露充分，患儿无呛咳、屏气现象，可避免置镜困难，减少声门、气道水肿及损伤，消除气管置镜引起的剧烈心血管反应；停药后可迅速苏醒，术后并发症少。
- Abstract:
- Objetive To investigate the anesthetic effect of sevoflurane combined with remifentanil intravenous anesthesia for pediatric tracheal foreign body removal surgery; and compare the advantages and disadvantages with the anesthetic method that is now commonly used in our department.Methods40 children with foreign bodies in bronchial， aged 2 to 5 years old， were randomly divided into two groups: sevoflurane and remifentanil anesthesia group (S group); ketamine and propofol combined with small doses of vecuronium anesthesia group ( K group). SpO2， HR， NBP and ECG were continuously monitored and recorded during the operation. and the operation time， recovery time， intraoperative laryngospasm and postoperative nausea and vomiting were observed and recorded.ResultsThere is significant difference of the heart rate and blood pressure before anesthesia ，before and after the tracheoscope examination in group S(P<005).There is significant difference of the heart rate and blood pressure before and after the tracheoscope examination between group S and group K(P<005). There is significant difference of recovery time between group S and group K(P<005). The muscle relaxation effect was satisfactory， the glottis was fully exposed， and there was no cough， breath holding phenomenon in both of the anesthetic methods.ConclusionSevoflurane combined with remifentanil intravenous anesthesia for pediatric foreign body removal surgery can provide satisfactory conditions for muscle relaxation， glottis is fully exposed， and there is no cough， breathhold phenomenon. That also avoid the difficulty of placing the tracheoscope， reduce the glottal airway edema and injury. It could be better to remove the severe cardiovascular response caused by tracheoscope examination and obtain stable vital signs during the operation. The children could awake quickly after stopping the anesthesia， reduce the postoperative complications.It is a more effective method of anesthesia.
参考文献/References:
1李赟，赵斯君，罗欣友.儿童支气管镜检292例临床分析［J］. 临床小儿外科杂志，2008，7（1）：45—46.
2王涛，谢艳丽，汪力.小儿气管异物围术期并发症的处理［J］. 临床小儿外科杂志，2012，11（5）：395—396.
3庄心良，曾因明，陈伯銮. 现代麻醉学［M］.第3 版.北京:人民卫生出版社，2003:1164.
4陈瑛琪，岳云，周海滨，等.七氟烷-咪达唑仑—瑞芬太尼麻醉诱导用于患者无肌松药气管插管的效果［J］.中华麻醉学杂志. 2009，5，409—411.
5张溪英，邝日裕，王江平. 婴儿呼吸道异物取出术不同麻醉方法的比较［J］.中国误诊学杂志，2008，8(34):8368—8367.
6Kang SH， Poynton MR， Kim KM， et al. Population pharmacokinetic and pharmacodynamic models of remifentanil in healthy volunteers using artificial neural network analysis［J］. Br J Clin Pharmacol，2007，64:3—13.
7Duffy CM，Matta BF. Sevoflurane and anesthesia for neurosurgery［J］. J Neurosurgi Anesthe， 2000，12: 128—140.
相似文献/References:
[1]李赟,赵斯君,罗欣友,等.儿童支气管镜检292例临床分析[J].临床小儿外科杂志,2008,7(01):17.
[2]张冬 易军 邵雷. 复合麻醉下空气灌肠治疗难复型肠套叠[J].临床小儿外科杂志,2012,11(05):393.
[J].Journal of Clinical Pediatric Surgery,2012,11(03):393.
[3]李忠,周旭坤,邓立军,等.全麻下再次空气灌肠治疗难复性小儿肠套叠16例[J].临床小儿外科杂志,2013,12(03):250.[doi:10.3969/j.issn.1671—6353.2013.03.029]
[4]滑蕾 张建敏 李立晶. 不同剂量瑞芬太尼用于婴幼儿麻醉的效果比较[J].临床小儿外科杂志,2013,12(06):503.
[5]刘松华 李琼灿 程智刚. 间歇通气呼吸暂停麻醉法在儿童输尿管软镜钬激光碎石术中的应用[J].临床小儿外科杂志,2013,12(06):506.
[6]王江平 陈政 肖婷.HC可视喉镜在儿童会厌囊肿手术麻醉中的应用[J].临床小儿外科杂志,2015,14(01):59.
[7]刘晶晶,安频,朱诗利,等. 舒芬太尼减轻小儿全麻苏醒期躁动的临床观察[J].临床小儿外科杂志,2016,15(02):196.
[8]张琴琴,赵媛,孔高茵,等. 头皮神经阻滞联合瑞芬太尼靶控输注在小儿开颅手术麻醉中的应用[J].临床小儿外科杂志,2016,15(06):621.
[9]蔡晶晶,吕红,刘国亮,等.右旋美托咪定在急诊婴幼儿气管异物取出术麻醉中的应用[J].临床小儿外科杂志,2017,16(04):368.
[10]李佳,威力江·赛买提,帕洛克·迪力木拉提,等.钬激光治疗后尿道瓣膜疾病的疗效评价[J].临床小儿外科杂志,2017,16(04):399.