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目的比较2种静脉麻醉方法用于小儿泌尿外科手术的临床效果。方法将40例择期行泌尿外科手术的患儿随机分为丙泊酚复合雷米芬太尼、芬太尼组(Ⅰ组)及咪达唑仑复合氯胺酮组(Ⅱ组),各20例。对比2组麻醉前(T1)、诱导时(T2)、气管插管时(T3)、手术开始时(T4)、手术开始30 min(T5)、拔管时(T6)心率(HR)、血压变化及呼吸恢复时间、睁眼时间和拔管时间。结果与T1比较,Ⅰ组T2时收缩压(SBP)、舒张压(DBP)下降,HR减慢(Pa<0.05),Ⅱ组T2时SBP、DBP升高,HR增加(Pa<0.05);与T1相比,Ⅰ组患儿T3、T4、T5、T6SBP、DBP和HR无明显改变(Pa>0.05),Ⅱ组T3、T4、T5、T6时SBP、DBP升高,HR增加,差异均有统计学意义(Pa<0.05);2组患儿SBP、DBP和HR在T2、T3、T4、T5、T6时间点比较,差异均有统计学意义(Pa<0.05);麻醉恢复期Ⅰ组呼吸恢复时间、睁眼时间和拔管时间均明显短于Ⅱ组(Pa<0.01)。结论丙泊酚复合雷米芬太尼、芬太尼组麻醉起效快、术中循环稳定、苏醒迅速、术后镇痛效果好,是理想、安全的麻醉方法。
Objective To compare the clinical effects of two kinds of intravenous anesthesia in pediatric urology. Methods Forty children undergoing elective urologic surgery were randomly divided into propofol combined with remifentanil, fentanyl group and midazolam combined ketamine group (n = 20). The changes of heart rate (HR), blood pressure (T6) at the time of extubation (T6) were compared between the two groups before anesthesia (T1), induction (T2), intubation (T3), at the beginning of operation (T4), 30 min Change and respiration time, eyes open time and extubation time. Results Compared with T1, the systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the HR decreased (P <0.05) at T2, and the SBP and DBP increased at T2 (P <0.05) T1, T3, T4, T5, T6SBP, DBP and HR did not change significantly in group Ⅰ (P> 0.05). The SBP, DBP and HR increased in group Ⅱ at T3, T4, T5 and T6 (P <0.05). There were significant differences in SBP, DBP and HR between the two groups at T2, T3, T4, T5 and T6 time points (Pa0.05) Recovery time, eyes open time and extubation time were significantly shorter than the group Ⅱ (Pa <0.01). Conclusion Propofol combined remifentanil and fentanyl anesthesia fast onset, intraoperative cycle stability, rapid recovery, postoperative analgesic effect is good, is an ideal and safe method of anesthesia.