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目的探讨瑞芬太尼-异丙酚麻醉在小儿气管异物取出术中的应用效果、血流动力学变化及并发症情况。方法选择ASA分级Ⅰ～Ⅲ级标准、年龄1～5岁、行气管异物取出术患儿30例,随机分为两组,每组15例。瑞芬太尼复合异丙酚组(RP组)氯胺酮5～8 mg/kg肌肉注射,异丙酚2 mg/kg静脉诱导,术中持续泵注异丙酚1～2 mg/(kg.h)及瑞芬太尼0.03～0.08μg/(kg.min),异物取出后停止给药。γ-羟基丁酸钠复合氯胺酮组(γk组)氯胺酮5～8 mg/kg肌肉注射,静脉注射γ-羟丁酸钠60～80 mg/kg诱导麻醉,术中麻醉深度不足时分次静脉滴注氯胺酮1.5 mg/kg至麻醉满意,并根据手术需要分次追加氯胺酮1 mg/kg。记录麻醉前、诱导、下镜、探查、取出、术毕各时间平均动脉压、心率及动脉血氧饱和度。观察两组苏醒时间,对比两组患儿拔管后上呼吸道梗阻或屏气、苏醒期躁动、术后恶心呕吐的发生率。结果 RP组诱导、下镜、探查、取出时平均动脉压、呼吸、心率、血氧饱和度较麻醉前均有下降(P<0.05),但尚在正常范围,与γK组相比差异亦有统计学意义(P<0.05)。瑞芬太尼起效迅速,恶心呕吐、苏醒期躁动、支气管痉挛和术后舌后坠的发生较对照组少,苏醒时间短,而且苏醒效果佳,与对照组相比差异有统计学意义(P<0.05)。结论瑞芬太尼、丙泊酚复合静脉麻醉可安全有效地用于小儿气管异物取出术,并具有血流动力学稳定、手术麻醉患儿苏醒时间短和苏醒质量高的优点。
Objective To investigate the effect of remifentanil-propofol anesthesia in the removal of pediatric tracheal foreign bodies, hemodynamic changes and complications. Methods ASA grading Ⅰ ~ Ⅲ grade criteria were selected, aged 1 to 5 years. Thirty children with tracheal foreign bodies were randomly divided into two groups (n = 15 in each group). Remifentanil combined propofol group (RP group) ketamine 5 ~ 8 mg / kg intramuscular injection of propofol 2 mg / kg intravenous infusion of intraoperative continuous infusion of propofol 1 ~ 2 mg / (kg.h ) And remifentanil 0.03 ~ 0.08μg / (kg.min), after the removal of foreign body to stop administration. γ-hydroxybutyrate complex ketamine group (γk group) ketamine 5-8 mg / kg intramuscular injection of sodium gamma-hydroxybutyrate 60 ~ 80 mg / kg induction of anesthesia, intraoperative intravenous drip Ketamine 1.5 mg / kg to anesthesia satisfaction, and according to the need for surgery add ketamine 1 mg / kg. Record before anesthesia, induction, the next mirror, exploration, removal, surgery at each time mean arterial pressure, heart rate and arterial oxygen saturation. The recovery time of the two groups was observed. The incidence of postoperative nausea and vomiting was compared between the two groups after extubation. Results The mean arterial pressure, respiration rate, heart rate and oxygen saturation in RP group were significantly lower than those before anesthesia (P <0.05), but were still in the normal range when compared with those in γK group Statistical significance (P <0.05). Remifentanil had rapid onset, nausea and vomiting, restlessness during wakeful period, bronchial spasm and delayed posterior lingual tongue injury compared with control group, short recovery time and good awakening effect, which were significantly different from the control group P <0.05). Conclusion Remifentanil and propofol combined with intravenous anesthesia can be safely and effectively used in children with tracheal foreign body removal and have the advantages of stable hemodynamics and short recovery time and high awakening quality in children with surgical anesthesia.