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目的探讨七氟醚复合瑞芬太尼麻醉在小儿唇裂修复术中的可行性及安全性。方法唇裂患儿48例,年龄4-36个月,随机分为瑞芬太尼组(R组)和氯胺酮组(K组),每组各24例。所有患儿均禁食6h、禁饮4h,术前30min肌注阿托品0.01mg/kg,入室后多功能监测ECG、SBP、DBP、HR、SPO2。麻醉诱导:七氟醚和氧气混合气体行密闭面罩缓慢诱导,缓慢静注阿曲库铵0.5mg/kg,经口气管插管。麻醉维持:瑞芬太尼组(R组)给予瑞芬太尼6μg.kg-1.h-1持续泵入,氯胺酮组(K组)给予氯胺酮1mg.kg-1.h-1持续泵入,两组均吸入七氟醚,调节七氟醚浓度2.5-3%维持麻醉深度。结果两组患儿的性别、年龄、体重、手术时间、术中出血量的比较无统计学意义(P>0.05),R组清醒时间、拔管时间较K组明显缩短(P<0.05),R组拔管后恶心呕吐、躁动、喉、支气管痉挛发生率较明显小(P<0.05)。结论七氟醚在两组小儿术中均有快速而平稳的吸入诱导,复合瑞芬太尼全麻用于唇裂修补术患者,血液动力学稳定苏醒迅速,术后并发症发生率低,有一定的临床应用价值。
Objective To investigate the feasibility and safety of sevoflurane combined with remifentanil anesthesia in pediatric cleft lip repair. Methods Forty-eight cases of cleft lip were randomly divided into remifentanil group (R group) and ketamine group (K group), 24 to 24 months in each group. All children were fasted 6h, forbidden to drink 4h, preoperative 30min intramuscular injection of atropine 0.01mg / kg, after the multifunction monitoring ECG, SBP, DBP, HR, SPO2. Anesthesia induction: A mixture of sevoflurane and oxygen was slowly induced in a confined mask, slowly intravenous infusion of atracurium 0.5 mg / kg intubated. Anesthesia maintenance: remifentanil group (R group) was given remifentanil 6μg.kg-1.h-1 continued to pump, ketamine group (K group) given ketamine 1mg.kg-1.h-1 continued to pump , Both groups inhaled sevoflurane, sevoflurane concentration adjusted 2.5-3% to maintain the depth of anesthesia. Results There was no significant difference in gender, age, weight, operation time and blood loss between the two groups (P> 0.05). The awake time and extubation time in group R were significantly shorter than those in group K (P <0.05) The incidence of nausea and vomiting, restlessness, larynx and bronchospasm in R group after extubation was significantly lower (P <0.05). Conclusion Sevoflurane has a rapid and steady induction of inhalation in both groups. Sevoflurane combined with remifentanil anesthesia for patients with cleft lip repair, stable and rapid recovery of hemodynamics, low incidence of postoperative complications, there is a certain The clinical value.