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目的:探讨丙泊酚和雷米芬太尼靶控输注在小儿尿道下裂成形术中的临床应用效果。方法:选择50例5～8岁、ASAI～II级择期行尿道下裂成形术的患儿,采用丙泊酚3μg/ml(Marsh模式)和雷米芬太尼3ng/ml(Minto模式)的血浆浓度,观察麻醉前(T0)、注药后5min(T1)、插入喉罩后即刻(T2)、插入喉罩后5min(T3)、10min(T4)、30min(T5)和拔除喉罩时(T6)的血压、心率变化情况。记录停药后患儿呼吸、意识恢复时间,停药至拔除喉罩的时间,观察术中知晓、术后恶心、呕吐情况。结果:注药后5min血压、心率都有一定程度下降(P<0.05),但插入喉罩后恢复到麻醉前水平,术中生命体征平稳。手术时间(124.5±21.7)min,停药至呼吸恢复时间(8.9±2.7)min,停药至意识恢复时间(13.1±5.2)min,停药至拔管时间(15.4±6.1)min。所有患儿无术中知晓,术后均无恶心、呕吐发生。结论:丙泊酚、雷米芬太尼靶控输注用于小儿尿道下裂成形手术中是安全、有效的。
Objective: To investigate the clinical effect of target controlled infusion of propofol and remifentanil in pediatric hypospadias. Methods: Fifty children aged 5 to 8 years undergoing ASAI stage II hypospadias were selected. Propofol 3μg / ml (Marsh model) and remifentanil 3ng / ml (Minto model) Plasma concentration was measured before anesthesia (T0), 5min after injection (T1), immediately after insertion of laryngeal mask (T2), 5min after insertion of laryngeal mask (T3), 10min (T4), 30min (T6) blood pressure, heart rate changes. Record after stopping children breathing, consciousness recovery time, withdrawal to laryngeal mask removal time to observe the intraoperative awareness, postoperative nausea, vomiting. Results: The blood pressure and heart rate decreased to some extent 5 minutes after injection (P <0.05), but returned to the level before anesthesia after insertion of laryngeal mask, and the vital signs were stable during operation. The duration of operation was (124.5 ± 21.7) min, the duration of resuscitation was 8.9 ± 2.7 min, the duration of recovery was (13.1 ± 5.2) min and withdrawal time was 15.4 ± 6.1 min. All patients without intraoperative awareness, no nausea after surgery, vomiting. Conclusion: Propofol and remifentanil target-controlled infusion is safe and effective in the treatment of pediatric hypospadias.