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目的:探讨小儿眼科手术中瑞芬太尼与丙泊酚复合静脉麻醉的用法及效果。方法:选取我院收治的82例需行眼科手术的患儿,随机分为观察组和对照组各41例。两组采取相同的基础处置:常规禁食禁水,术前30 min肌肉注射阿托品0.02 mg/kg、苯巴比妥钠2.0 mg/kg等。在此基础上,观察组采用瑞芬太尼联合丙泊酚静脉麻醉:诱导期给予丙泊酚4.0 mg/kg、阿曲库铵0.6 mg/kg、瑞芬太尼1μg/kg缓慢静脉注射,维持期给予微型泵输注瑞芬太尼0.5μg/kg、丙泊酚7 mg/kg;对照组采用芬太尼联合丙泊酚静脉麻醉:诱导期给予丙泊酚4.0 mg/kg、阿曲库铵0.6 mg/kg、芬太尼3μg/kg,维持期给予芬太尼1.5μg/kg、丙泊酚7 mg/kg,给药方法同观察组。两组手术完毕前10 min停用麻醉药并给予曲马多1 mg/kg。观察并记录麻醉诱导前(T1)、麻醉诱导后(T2)、插管后1 min内(T3)、手术开始5 min时(T4)、手术结束时(T5)、拔管时(T6)患儿的心率(HR)、血压(BP),以及患儿苏醒时间、拔管时间、术后不良反应情况。结果:两组HR与BP在T2～T6五个时间点与T1比较差异均有统计学意义(P<0.05);观察组T2～T6相邻两个时间点比较,HR、BP差异无统计学意义(P>0.05);对照组在T3、T4及T6的HR、BP高于观察组(P<0.05);观察组苏醒、拔管时间明显短于对照组(P<0.01);观察组术后呼吸困难、恶心呕吐、低血氧及躁动发生率低于对照组(P<0.05)。结论:瑞芬太尼联合丙泊酚静脉麻醉用于小儿眼科手术,术中血流动力学较稳定,术后患儿苏醒迅速,苏醒质量较好,是一种安全可行的静脉麻醉方法。
Objective: To investigate the usage and effect of intravenous anesthesia with remifentanil and propofol in pediatric ophthalmic surgery. Methods: A total of 82 children admitted to our hospital undergoing ophthalmic surgery were randomly divided into observation group (41 cases) and control group (41 cases). The two groups took the same basic treatment: routine fasting and water forbidden, intramuscular injection of atropine 0.02 mg / kg, phenobarbital sodium 2.0 mg / kg 30 min before surgery. On the basis of this, the observation group was given remifentanil with propofol intravenous anesthesia: Propofol 4.0 mg / kg, Atracurium 0.6 mg / kg, Remifentanil 1 μg / kg during the induction period, During the maintenance period, remifentanil 0.5 μg / kg and propofol 7 mg / kg were given to the mini-pump. In the control group, fentanyl and propofol were used for intravenous anesthesia. Propofol 4.0 mg / kg, Trehalose 0.6 mg / kg, fentanyl 3 μg / kg, and fentanyl 1.5 μg / kg and propofol 7 mg / kg for the maintenance period. The administration method was the same as the observation group. Both groups discontinued anesthesia 10 minutes before surgery and given tramadol 1 mg / kg. Observed and recorded before anesthesia induction (T1), after induction of anesthesia (T2), within 1 min after intubation (T3), 5 min after the start of surgery (T4), at the end of surgery (T5) Children’s heart rate (HR), blood pressure (BP), and the recovery time of children, extubation time, postoperative adverse reactions. Results: The HR and BP between the two groups at T2 ~ T6 at five time points were significantly different from T1 (P <0.05). There were no significant differences in HR and BP between two adjacent time points in T2 ~ T6 in observation group (P> 0.05). The HR and BP of the control group at T3, T4 and T6 were significantly higher than those of the observation group (P <0.05). The recovery time and extubation time of the observation group were significantly shorter than those of the control group (P <0.01) Post-dyspnea, nausea and vomiting, hypoxemia and agitation were lower than those in the control group (P <0.05). Conclusion: Remifentanil combined with propofol intravenous anesthesia for pediatric ophthalmic surgery, intraoperative hemodynamics is relatively stable, postoperative recovery of children with rapid recovery of quality is good, is a safe and feasible method of intravenous anesthesia.