国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2009年
19期
65-68
,共4页
麻醉方法%扁桃体、腺样体切除%小儿
痳醉方法%扁桃體、腺樣體切除%小兒
마취방법%편도체、선양체절제%소인
Anesthesia methods%Tonsillectomy and adenoidectomy%Children
目的 不同的麻醉方法用于扁桃体、腺样体切除的患儿血流动力学、术后苏醒过程及并发症发生的情况.探讨适合于小儿较为安全、有效的麻醉与镇痛方法.方法选择ASAⅠ级择期行扁桃体及腺样体切除术的患儿90例,随机分为3组,Ⅰ组:芬太尼-异氟醚静吸复合全麻组;Ⅱ组:瑞芬太尼-丙泊酚全凭静脉麻组;Ⅲ组:瑞芬太尼-丙泊酚-曲马多全凭静脉麻组,每组30例.术中分别记录三组患儿诱导前(T1)、插管时(T2)、腺样体切除时(T3)、拔管后即刻(T4)、清醒时(T5)各时间点SBP、DBP、HR、SPO2;观察3组患儿停药至气管拔管,苏醒及清醒的时间,拔管后上呼吸道梗阻或屏气.躁动,恶性、呕吐发生的情况,以及在恢复室30min时疼痛的评分.结果3组患儿麻醉诱导前、插管时、腺样体切除时,血压、心率、氧饱和度的变化无统计学意义(P>0.05);拔管后即刻,Ⅰ组血压、心率分别高于Ⅱ组、Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组血压、心率、氧饱和度与Ⅲ组相比差异无统计学意义(P>0.05).停药至气管拔管时间,苏醒时间,清醒时间,Ⅰ组分别长于Ⅱ组和Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组相比差异无统计学意义(P>0.05).上呼吸道梗阻或屏气、恶心呕吐、躁动Ⅰ组明显多于Ⅱ组和Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组相比差异无统计学意义(P>0.05).术后疼痛评分,Ⅱ组明显高于Ⅰ组和Ⅲ组,差异有统计学意义(P<0.05);Ⅱ组与Ⅲ组相比差异无统计学意义(P>0.05).结论瑞芬太尼复合丙泊酚维持术中的麻醉,手术结束停药即给予曲马多,可获得良好的麻醉效果,诱导平稳,苏醒快,质量高.
目的 不同的痳醉方法用于扁桃體、腺樣體切除的患兒血流動力學、術後囌醒過程及併髮癥髮生的情況.探討適閤于小兒較為安全、有效的痳醉與鎮痛方法.方法選擇ASAⅠ級擇期行扁桃體及腺樣體切除術的患兒90例,隨機分為3組,Ⅰ組:芬太尼-異氟醚靜吸複閤全痳組;Ⅱ組:瑞芬太尼-丙泊酚全憑靜脈痳組;Ⅲ組:瑞芬太尼-丙泊酚-麯馬多全憑靜脈痳組,每組30例.術中分彆記錄三組患兒誘導前(T1)、插管時(T2)、腺樣體切除時(T3)、拔管後即刻(T4)、清醒時(T5)各時間點SBP、DBP、HR、SPO2;觀察3組患兒停藥至氣管拔管,囌醒及清醒的時間,拔管後上呼吸道梗阻或屏氣.躁動,噁性、嘔吐髮生的情況,以及在恢複室30min時疼痛的評分.結果3組患兒痳醉誘導前、插管時、腺樣體切除時,血壓、心率、氧飽和度的變化無統計學意義(P>0.05);拔管後即刻,Ⅰ組血壓、心率分彆高于Ⅱ組、Ⅲ組,差異有統計學意義(P<0.05);Ⅱ組血壓、心率、氧飽和度與Ⅲ組相比差異無統計學意義(P>0.05).停藥至氣管拔管時間,囌醒時間,清醒時間,Ⅰ組分彆長于Ⅱ組和Ⅲ組,差異有統計學意義(P<0.05);Ⅱ組與Ⅲ組相比差異無統計學意義(P>0.05).上呼吸道梗阻或屏氣、噁心嘔吐、躁動Ⅰ組明顯多于Ⅱ組和Ⅲ組,差異有統計學意義(P<0.05);Ⅱ組與Ⅲ組相比差異無統計學意義(P>0.05).術後疼痛評分,Ⅱ組明顯高于Ⅰ組和Ⅲ組,差異有統計學意義(P<0.05);Ⅱ組與Ⅲ組相比差異無統計學意義(P>0.05).結論瑞芬太尼複閤丙泊酚維持術中的痳醉,手術結束停藥即給予麯馬多,可穫得良好的痳醉效果,誘導平穩,囌醒快,質量高.
목적 불동적마취방법용우편도체、선양체절제적환인혈류동역학、술후소성과정급병발증발생적정황.탐토괄합우소인교위안전、유효적마취여진통방법.방법선택ASAⅠ급택기행편도체급선양체절제술적환인90례,수궤분위3조,Ⅰ조:분태니-이불미정흡복합전마조;Ⅱ조:서분태니-병박분전빙정맥마조;Ⅲ조:서분태니-병박분-곡마다전빙정맥마조,매조30례.술중분별기록삼조환인유도전(T1)、삽관시(T2)、선양체절제시(T3)、발관후즉각(T4)、청성시(T5)각시간점SBP、DBP、HR、SPO2;관찰3조환인정약지기관발관,소성급청성적시간,발관후상호흡도경조혹병기.조동,악성、구토발생적정황,이급재회복실30min시동통적평분.결과3조환인마취유도전、삽관시、선양체절제시,혈압、심솔、양포화도적변화무통계학의의(P>0.05);발관후즉각,Ⅰ조혈압、심솔분별고우Ⅱ조、Ⅲ조,차이유통계학의의(P<0.05);Ⅱ조혈압、심솔、양포화도여Ⅲ조상비차이무통계학의의(P>0.05).정약지기관발관시간,소성시간,청성시간,Ⅰ조분별장우Ⅱ조화Ⅲ조,차이유통계학의의(P<0.05);Ⅱ조여Ⅲ조상비차이무통계학의의(P>0.05).상호흡도경조혹병기、악심구토、조동Ⅰ조명현다우Ⅱ조화Ⅲ조,차이유통계학의의(P<0.05);Ⅱ조여Ⅲ조상비차이무통계학의의(P>0.05).술후동통평분,Ⅱ조명현고우Ⅰ조화Ⅲ조,차이유통계학의의(P<0.05);Ⅱ조여Ⅲ조상비차이무통계학의의(P>0.05).결론서분태니복합병박분유지술중적마취,수술결속정약즉급여곡마다,가획득량호적마취효과,유도평은,소성쾌,질량고.
Objective To compare the advantages and the disadvantnges among the different anesthesia methods in children for tortsillectomy and adenoidectomy.Methods 90 cases with ASA Ⅰscheduled for tonsillectomy and adenoidectomy.The children were. randomly divided into three, groups.Patients in group Ⅰ received Fentanil combined with Isoflurane general anesthesia;patients in group Ⅱ received Remifentanil combined with Propofol general anesthesia and patients in group Ⅲ received Remifentanil combined with Propofol and Tramadol general anesthesia.Observing SBP、DBP、HR、SPO2 at the time that before inducing, inserting tube, adenoidectomy, pulling out tube, the recovery time, incidental of side effect, and post operative pain score VAS.Results Tthere were no significant difference on the SBP、DBP、HR、SPO2 at the time before induction, ntubation.After adenoidectomy in these three groups (P > 0.05). SBP、DBP、HR in group Ⅰ were larger than in group Ⅱ，Ⅲ (P < 0.05) at the time after extuhation. The recovery time of anesthesia was significantly longer in the group Ⅰ than in the group Ⅱ,Ⅲ incidena of the upper respiratory tract obstruction,nausea,vomiting, and restless more were higher in the group Ⅰ than in the group Ⅱ,Ⅲ (P < 0.05).Post operative pain score was significantly higher in the group Ⅱ than in the group Ⅰ and Ⅲ(P < 0.05). Conclusions remifentanil combined with Propofol and Pramadol general anesthesia is a effective anes-thesia methods for tonsillectomy and adenoidectomy in children,and it can wake induce stably,recover fast, and completely.
