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目的通过对丙泊酚联合瑞芬太尼喉罩麻醉与氯胺酮复合丙泊酚麻醉在小儿眼科手术中的比较,探讨丙泊酚联合瑞芬太尼喉罩麻醉方法在小儿眼科手术中的可行性与安全性。方法选择该院66例择期眼科手术患儿,年龄1~8岁,ASAⅠ~Ⅱ级,随机分为二组:瑞芬太尼组(A组)和氯胺酮组(B组)。A组患儿缓慢静脉注射丙泊酚3 mg/kg和瑞芬太尼2μg/kg,待患儿体动消失、下颌松弛后置入喉罩,给予机械通气,以瑞芬太尼0.25~0.3μg/(kg·min)和丙泊酚8~10mg/(kg·min)静滴维持。B组肌肉注射氯胺酮6~8mg/kg和静脉注射丙泊酚2~3 mg/kg,保留患儿自主呼吸,面罩吸氧2L/min,以丙泊酚8~10μg/(kg·min)静滴维持,根据手术需要间断静脉注射氯胺酮0.5~1mg/kg。记录并分析二组患儿麻醉前(T1),麻醉后5min(T2),手术开始时(T3),手术开始后10min(T4)以及手术结束时(T5)患儿的HR、MAP、SpO2、手术时间、患儿Aldrete评分达9分时间、麻醉恢复室(PACU)停留时间和围术期不良反应。结果 1A组患儿在手术过程中HR和MAP的波动变化显著优于B组患儿(P<0.05);2二组患儿在手术时间上差异无统计学意义(P>0.05);3A组患儿在Aldrete评分达9分时间、离开PACU时间明显优于B组患儿(P<0.05);在术后躁动、恶心呕吐的发生率上,A组患儿显著低于B组患儿(P<0.05)。结论小儿眼科手术中使用丙泊酚联合瑞芬太尼喉罩麻醉较使用氯胺酮麻醉效果好,可控性强,术后苏醒快,不良反应少,能够保证患儿围术期安全,是小儿眼科手术的新选择。
Objective To investigate the feasibility of propofol combined with remifentanil anesthesia in pediatric ophthalmic surgery through propofol combined with remifentanil anesthesia and ketamine combined with propofol anesthesia in pediatric ophthalmic surgery And safety. Methods Sixty-six children undergoing elective ophthalmologic operation, aged 1 to 8 years and ASA Ⅰ ~ Ⅱ were randomly divided into two groups: remifentanil group (A group) and ketamine group (B group). A group of children with a slow intravenous injection of propofol 3 mg / kg and remifentanil 2μg / kg until the children disappeared body movements, laxity after the mandible into laryngeal mask, given mechanical ventilation to remifentanil 0.25 ~ 0.3 μg / (kg · min) and propofol 8 ~ 10mg / (kg · min) intravenous maintenance. Group B received intramuscular injection of ketamine 6-8 mg / kg and intravenous infusion of propofol 2-3 mg / kg. The spontaneous respiration of the children was maintained and the mask was oxygenated by 2 L / min. The rats were anesthetized with 8-10 μg / (kg · min) propofol Drip maintenance, according to the need for intermittent intravenous injection of ketamine 0.5 ~ 1mg / kg. The HR, MAP, SpO2, MAP of Sprague-Dawley rats in the two groups were recorded and analyzed before anesthesia (T1), 5 min after anesthesia (T2), at the beginning of the operation (T3), 10 min after the operation (T4) and at the end of the operation The operation time, Aldrete score in children up to 9 minutes, anesthesia recovery room (PACU) residence time and perioperative adverse reactions. Results The fluctuation of HR and MAP during surgery in group 1A was significantly better than that in group B (P <0.05). There was no significant difference in the operation time between the two groups (P> 0.05) Children with Aldrete score of 9 points, leaving the PACU time was significantly better than the B group (P <0.05); in the postoperative agitation, nausea and vomiting incidence, children in group A was significantly lower than those in group B ( P <0.05). Conclusion Propofol combined with remifentanil laryngeal mask anesthesia in pediatric ophthalmic surgery than ketamine anesthesia, strong controllable, rapid recovery after surgery, fewer adverse reactions, to ensure the safety of children perioperative, is a pediatric ophthalmology The new choice of surgery.