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目的评价瑞芬太尼复合丙泊酚全凭(TCT)静脉麻醉用于小儿脑瘫的临床效果。方法选择择期需全麻下行肌力肌张力调整术或者行颈动脉剥脱术手术的患儿50例,随机分成A组和B组各25例。A组麻醉诱导(咪达唑仑0.2mg/kg、丙泊酚1.0mg/kg、瑞芬太尼1.5μg/kg、琥珀胆碱2mg/kg)。麻醉维持连续靶控输注丙泊酚2～4mg/(kg·h)微量持续泵注瑞芬太尼0.1～0.25μg/(kg·min)能用肌松剂的维库溴胺0.03μg/(kg·min)B组麻醉实施中麻醉诱导中瑞芬太尼改用芬太尼0.5～1μg/kg麻醉维持中微量泵持续泵入瑞芬太尼改为间断推注芬太尼0.1μg/(kg·min)其余药物使用方法及剂量同A组。结果丙泊酚联合瑞芬太尼比丙泊酚联合芬太尼更能有效的控制麻醉诱导和手术过程中血压和心率的上升并且使用瑞芬太尼组的患儿苏醒时间及拔管时间较使用芬太尼组明显缩短,术中丙泊酚的用量也大大减少。结论丙泊酚联合瑞芬太尼适用于脑瘫患儿手术,且效果优于丙泊酚联合芬太尼。
Objective To evaluate the clinical effect of remifentanil combined with propofol (TCT) intravenous anesthesia on pediatric cerebral palsy. Methods Fifty children undergoing general anesthesia for muscle tone adjustment or undergoing carotid artery dissection were randomly divided into group A and group B, with 25 cases each. Group A received anesthesia induction (midazolam 0.2 mg / kg, propofol 1.0 mg / kg, remifentanil 1.5 μg / kg, succinylcholine 2 mg / kg). Anesthesia Continuous target-controlled infusion of propofol 2 ~ 4mg / (kg · h) Trace continuous infusion Remifentanil 0.1 ~ 0.25μg / (kg · min) Vecuronium with muscle relaxants 0.03μg / (kg · min) Group B anesthesia in the induction of anesthesia remifentanil to use fentanyl 0.5 ~ 1μg / kg anesthesia to maintain the pump to the continuous infusion of remifentanil intermittent bolus injection of fentanyl 0.1μg / (kg · min) The remaining drug use and dose with the A group. Results Compared with propofol and fentanyl, propofol and remifentanil were more effective in controlling the induction of anesthesia and the increase of blood pressure and heart rate during operation, and the recovery time and extubation time in remifentanil group Fentanyl group was significantly shorter, intraoperative use of propofol is also greatly reduced. Conclusion Propofol combined with remifentanil is suitable for children with cerebral palsy surgery and its effect is superior to that of propofol combined with fentanyl.