Zhu Shili,Wu Lei,He Bin,et al.Efficacy and safety of ciprofol plus remifentanil anesthesia during tethered cord surgery[J].Journal of Clinical Pediatric Surgery,2023,22(06):549-553.[doi:10.3760/cma.j.cn101785-202203081-010]
环泊酚复合瑞芬太尼麻醉用于儿童脊髓拴系手术的疗效与安全性探讨
- Title:
- Efficacy and safety of ciprofol plus remifentanil anesthesia during tethered cord surgery
- Keywords:
- Remifentanil; Anesthesia; Tethered Cord Syndrome; Surgical Procedures; Operative; Treatment Outcome; Child
- 摘要:
- 目的 探讨环泊酚复合瑞芬太尼全凭静脉麻醉用于儿童脊髓拴系手术的疗效与安全性。方法 本研究为前瞻性研究，以2021年9月至2022年2月于湖南省儿童医院接受全身麻醉下行脊髓拴系松解术的终丝型脊髓拴系综合征患儿为研究对象，共66例，随机分为丙泊酚组（propofol group，P组）和环泊酚组（ciprofol group，C组），每组各33例。两组麻醉诱导均使用咪达唑仑（0.1 mg/kg）、舒芬太尼（0.5 μg/kg）和顺式阿曲库铵（0.15 mg/kg）；P组静脉注射丙泊酚（2 mg/kg），C组静脉注射环泊酚（0.4 mg/kg）。脑电双频指数（bispectral index，BIS）值小于或等于45后行气管插管。术中麻醉维持采用静脉泵注瑞芬太尼（0.1~1 μg·kg-1·min-1）加丙泊酚（4~12 mg·kg-1·h-1）（P组）或环泊酚（1~3 mg·kg-1·h-1）（C组）。记录两组术后气管插管拔管时间，静脉泵注麻醉药总量，气管插管前（T1）、气管插管后（T2）、切皮时（T3）、切开硬膜时（T4）、手术结束时（T5）以及拔管时（T6）的心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）、脉搏血氧饱和度（pulse oxygen saturation，SpO2）、BIS，拔管后10 min Ramsay镇静评分（Ramsay sedation score）以及围麻醉期不良事件发生情况。采用SPSS 19.0进行统计学分析。结果 两组拔管时间[P组（33.42±1.92） min比C组（33.00±1.76） min]、瑞芬太尼输注量[P组（528.84±46.82）μg比C组（504.84±43.16）μg]、输液量[P组（492.7±32.26） mL比C组（450.0±29.27） mL]、失血量[P组（7.73±0.66） mL比C组（7.27±0.69） mL]、尿量[P组（110.61±13.64） mL比C组（106.78±8.44） mL]，以及各时间段HR、MAP、BIS值比较，差异均无统计学意义（P>0.05）；拔管后Ramsay镇静评分P组（2.27±0.08）分高于C组（2.03±0.05）分；注射痛的发生率P组（5/28）显著高于C组（0/33）；丙泊酚输注量[（287.12±26.15） mg]为环泊酚输注量[（68.86±4.92） mg]的4.17倍，与丙泊酚和环泊酚的临床效价比相符合。结论 与丙泊酚相比，环泊酚复合瑞芬太尼全凭静脉麻醉应用于儿童脊髓拴系手术注射痛发生率低，术后镇静评分低，能安全有效用于该类手术的麻醉管理。
- Abstract:
- Objective To explore whether total intravenous anesthesia with ciprofol combined with remifentanil is safe and effective for tethered cord surgery in children.Methods A total of 66 children with tethered cord syndrome undergoing tethered cord release were randomized into two groups of propofol (p, n=33) and ciprofol (c, n=33).Both groups were induced with the same doses of midazolam, sufentanil and cisatracurium.Endotracheal intubation was performed after attaining intubation conditions.Intraoperative anesthesia was maintained by an intravenous infusion of remifentanil, propofol (group P) and ciprofol (group C).Total doses of anesthetics and time of extubation post-operation were recorded along with heart rate (HR), mean arterial pressure (MAP), finger pulse oxygen saturation (SPO2), depth of anesthesia (BIS) before intubation (T1), after intubation (T2), during skin incision (T3), during epidural incision (T4), at end of surgery (T5) and during extubation (T6).Ramsay score and adverse events were also analyzed.Results There were no significant differences in extubation time[Group P(33.42±1.92) min vs.Group C(33.00±1.76) min], remifentanil volume[Group P(528.84±46.82) μg vs. Group C(504.84±43.16) μg], intravenous infusion volume[Group P(492.7±32.26) mL vs.Group C(450.0±29.27) mL], blood loss volume[Group P(7.73±0.66) mL vs.Group C(7.27±0.69) mL], urine volume[Group P(110.61±13.64) mL vs.Group C(106.78±8.44) mL], HR, MAP and BIS between the two groups. The Ramsay Score in Group P(2.27±0.08) point was significantly higher than that in Group C(2.03±0.05) point The incidence ofinjection pain in Group P(5/28) was significantly higher than that in Group C(0/33). The propofol infusion (287.12±26.15) mg was 4.17 times as much as the ciprofol infusion(68.86±4.92) mg. Conclusion Compared with propofol, the incidence of injection pain and Ramsay Score of ciprofol is lower. Total intravenous anesthesia with ciprofol combined with remifentanil is safe and effective for tethered cord surgery in children.
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备注/Memo
收稿日期:2022-03-25。
基金项目:湖南省卫生健康委科研课题（202204113977）
通讯作者:屈双权,Email:qushuangquan1974@163.com