CAJ | 학술논문

目的：观察丙泊酚复合瑞芬太尼或丙泊酚复合七氟醚联合喉罩麻醉用于儿童先天性心脏病介入治疗的可行性和临床效果比较。方法选择ASAⅠ～Ⅱ级，择期行先天性心脏病介入治疗患儿40例，随机均分为丙泊酚＋瑞芬太尼（PR）组和丙泊酚＋七氟醚（PS）组。所有患儿均静脉注射氯胺酮2 mg· kg-1基础麻醉。麻醉诱导采用丙泊酚2 mg· kg-1，PR组用瑞芬太尼1μg· kg-1，PS组七氟醚吸入。待患儿意识消失下颌松弛后置入经典型喉罩。麻醉维持：PR组丙泊酚6 mg· kg-1· h-1，瑞芬太尼0．05～0．1μg· kg-1· min-1持续输注，PS组丙泊酚6 mg· kg -1· h-1，七氟醚1％～3％。观察2组诱导前（T0）、置喉罩时（T1）、置入喉罩后3 min（T2）、手术结束（T3）及拔除喉罩（T4）各时点的平均动脉压（MAP）、心率（HR）、脉搏氧饱和度（SpO2）、呼吸频率（RR）及呼气末二氧化碳分压（PETCO2）变化情况。观察术中及术后不良反应、苏醒时间等。结果在T1、T2及T3时点，2组HR、MAP及RR均较T0时下降（P＜0．05）。与PS组比较，PR组HR、MAP下降较明显，术后躁动、恶心呕吐发生率明显降低，但术后苏醒时间较长（ P＜0．05）。2组在各时间点的SpO2无统计学差异。在T1、T2时点PR组RR较PS组慢（P＜0．05），但对通气影响不大。结论丙泊酚复合瑞芬太尼或丙泊酚复合七氟醚麻醉都可安全用于儿童先天性心脏病介入治疗的麻醉管理，应用喉罩可相对更好地控制气道；丙泊酚复合七氟醚血流动力学更稳定，苏醒更迅速，但术后躁动、恶心呕吐发生率升高。
목적：관찰병박분복합서분태니혹병박분복합칠불미연합후조마취용우인동선천성심장병개입치료적가행성화림상효과비교。방법선택ASAⅠ～Ⅱ급，택기행선천성심장병개입치료환인40례，수궤균분위병박분＋서분태니（PR）조화병박분＋칠불미（PS）조。소유환인균정맥주사록알동2 mg· kg-1기출마취。마취유도채용병박분2 mg· kg-1，PR조용서분태니1μg· kg-1，PS조칠불미흡입。대환인의식소실하합송이후치입경전형후조。마취유지：PR조병박분6 mg· kg-1· h-1，서분태니0．05～0．1μg· kg-1· min-1지속수주，PS조병박분6 mg· kg -1· h-1，칠불미1％～3％。관찰2조유도전（T0）、치후조시（T1）、치입후조후3 min（T2）、수술결속（T3）급발제후조（T4）각시점적평균동맥압（MAP）、심솔（HR）、맥박양포화도（SpO2）、호흡빈솔（RR）급호기말이양화탄분압（PETCO2）변화정황。관찰술중급술후불량반응、소성시간등。결과재T1、T2급T3시점，2조HR、MAP급RR균교T0시하강（P＜0．05）。여PS조비교，PR조HR、MAP하강교명현，술후조동、악심구토발생솔명현강저，단술후소성시간교장（ P＜0．05）。2조재각시간점적SpO2무통계학차이。재T1、T2시점PR조RR교PS조만（P＜0．05），단대통기영향불대。결론병박분복합서분태니혹병박분복합칠불미마취도가안전용우인동선천성심장병개입치료적마취관리，응용후조가상대경호지공제기도；병박분복합칠불미혈류동역학경은정，소성경신속，단술후조동、악심구토발생솔승고。
Objective To evaluate the feasibility and effects of laryngeal mask airway ( LMA) and propofol com-bined with remifentanil or sevoflurane in interventional treatment of congenital heart disease in children .Methods 40 ASA I-II child patients were randomly divided into propofol +remifentanil ( PR) group and propofol +sevoflurane ( PS) group (20 in each) before intervention treatment of congenital heart disease .All patients underwent basic anesthesia by intravenous injection of 2 mg/kg ketamine followed by anesthesia induction with 2 mg/kg propofol.Then, the PR group received 1.0 g/kg of remifentanil , while the PS group inhaled sevoflurane .Next, LMA was applied in both groups once the patients became unconscious .For maintenance of anesthesia , 6 mg· kg-1 · h-1 of propofol and 0.05-0.1 μg· kg-1 · min-1 of remifentanil were delivered in the PR group through continuous infusion , while 6 mg · kg-1 · h-1 of propofol and 1%-3%of sevoflurane were given in the PS group .The mean arterial pressure ( MAP) , heart rate ( HR) , blood oxygen saturation (SpO2), respiratory rate (RR) and partial pressure of end -tidal carbon dioxide (PETCO2) val-ues of both groups were recorded before induction ( T0) , before and 3 min after implantation of laryngeal mask ( T1 and T2), at the end of surgery (T3) and after removal of laryngeal mask (T4) .Also, intraoperative and postoperative ad-verse reactions and awakening time were observed .Results The levels of HR , MAP and RR of both groups were lower at T1, T2 and T3 than at T0 (P<0.05).Compared with the PS group, the PR group presented remarkable reduction in HR and MAP, lower incidences of restlessness , nausea and vomiting, but delayed recovery from anesthesia (P<0.05). No statistical differences were found in SpO 2 of both groups at each time point .The RR had little effect on ventilation de-spite lower RR were recorded at T1 and T2 in the PR group than that in the PS group (P<0.05).Conclusions Propo-fol can be safely applied in combination with either remifentanil or sevoflurane for intervention treatment of congenital heart disease in children .LMA can be adopted for better airway control .When propofol is applied in combination with sevoflurane, patients can display more stable hemodynamic changes and shorter awakening time , despite higher inci-dences of postoperative restlessness , nausea and vomiting .