全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2014年
5期
521-523
,共3页
麻醉%舒芬太尼%瑞芬太尼%靶控输注%疝环结扎术
痳醉%舒芬太尼%瑞芬太尼%靶控輸註%疝環結扎術
마취%서분태니%서분태니%파공수주%산배결찰술
anesthesia%sufentanil%remifen-tanil%target-controlled infusion%hernia ring liga-tion
目的：评价小儿腹腔镜疝环结扎术中应用靶控输注丙泊酚复合舒芬太尼与瑞芬太尼的麻醉效果与安全性。方法将行腹腔镜疝环结扎术72例患儿，随机分为TCIS组和TCIR组，每组36例，TCIS组予靶控输注舒芬太尼复合丙泊酚诱导与维持麻醉，TCIR组予靶控输注瑞芬太尼复合丙泊酚诱导与维持麻醉。比较两组患儿围麻醉期血流动力学变化、术毕苏醒时间、气管拔管时间、丙泊酚用量和术后Riker镇静和躁动评分（SAS）评分、视觉模拟痛觉（VAS）评分。结果两组患儿在麻醉诱导前，各血流动力学指标差异无统计学意义（t分别=0.12、0.23、0.48、0.31，P均＞0.05）；与TCIS组患儿比较，TCIR组患儿在插管时（T1）的收缩压、舒张压较低，在拔管时（T2）收缩压、舒张压和心率较高，差异均有统计学意义（t分别=5.71、8.63；5.77、4.27、4.00，P均＜0.05）。两组患儿术毕苏醒时间、气管拔管时间和丙泊酚用量比较，差异均无统计学意义（t分别=0.91、1.14、0.94，P均＞0.05）。TCIS组患儿SAS、VAS评分均低与TCIR组，差异均有统计学意义（t分别=7.67、18.57，P均＜0.05）。结论靶控输注丙泊酚复合舒芬太尼用于小儿腹腔镜疝环结扎术，在围麻醉期血流动力学更加平稳、且能更加有效减少患儿术后躁动和疼痛，较复合瑞芬太尼效果佳。
目的：評價小兒腹腔鏡疝環結扎術中應用靶控輸註丙泊酚複閤舒芬太尼與瑞芬太尼的痳醉效果與安全性。方法將行腹腔鏡疝環結扎術72例患兒，隨機分為TCIS組和TCIR組，每組36例，TCIS組予靶控輸註舒芬太尼複閤丙泊酚誘導與維持痳醉，TCIR組予靶控輸註瑞芬太尼複閤丙泊酚誘導與維持痳醉。比較兩組患兒圍痳醉期血流動力學變化、術畢囌醒時間、氣管拔管時間、丙泊酚用量和術後Riker鎮靜和躁動評分（SAS）評分、視覺模擬痛覺（VAS）評分。結果兩組患兒在痳醉誘導前，各血流動力學指標差異無統計學意義（t分彆=0.12、0.23、0.48、0.31，P均＞0.05）；與TCIS組患兒比較，TCIR組患兒在插管時（T1）的收縮壓、舒張壓較低，在拔管時（T2）收縮壓、舒張壓和心率較高，差異均有統計學意義（t分彆=5.71、8.63；5.77、4.27、4.00，P均＜0.05）。兩組患兒術畢囌醒時間、氣管拔管時間和丙泊酚用量比較，差異均無統計學意義（t分彆=0.91、1.14、0.94，P均＞0.05）。TCIS組患兒SAS、VAS評分均低與TCIR組，差異均有統計學意義（t分彆=7.67、18.57，P均＜0.05）。結論靶控輸註丙泊酚複閤舒芬太尼用于小兒腹腔鏡疝環結扎術，在圍痳醉期血流動力學更加平穩、且能更加有效減少患兒術後躁動和疼痛，較複閤瑞芬太尼效果佳。
목적：평개소인복강경산배결찰술중응용파공수주병박분복합서분태니여서분태니적마취효과여안전성。방법장행복강경산배결찰술72례환인，수궤분위TCIS조화TCIR조，매조36례，TCIS조여파공수주서분태니복합병박분유도여유지마취，TCIR조여파공수주서분태니복합병박분유도여유지마취。비교량조환인위마취기혈류동역학변화、술필소성시간、기관발관시간、병박분용량화술후Riker진정화조동평분（SAS）평분、시각모의통각（VAS）평분。결과량조환인재마취유도전，각혈류동역학지표차이무통계학의의（t분별=0.12、0.23、0.48、0.31，P균＞0.05）；여TCIS조환인비교，TCIR조환인재삽관시（T1）적수축압、서장압교저，재발관시（T2）수축압、서장압화심솔교고，차이균유통계학의의（t분별=5.71、8.63；5.77、4.27、4.00，P균＜0.05）。량조환인술필소성시간、기관발관시간화병박분용량비교，차이균무통계학의의（t분별=0.91、1.14、0.94，P균＞0.05）。TCIS조환인SAS、VAS평분균저여TCIR조，차이균유통계학의의（t분별=7.67、18.57，P균＜0.05）。결론파공수주병박분복합서분태니용우소인복강경산배결찰술，재위마취기혈류동역학경가평은、차능경가유효감소환인술후조동화동통，교복합서분태니효과가。
Objective To evaluate the anesthetic effect and security of target-controlled infusion of propofol combined with sufentanil or remifentanil for anesthesia of laparoscopic hernia ring ligation. Methods A total of 72 cases of the la-paroscopic hernia ring ligation were randomly divided into TCIS group and TCIR group with 36 cases each. TCIS group was given with target-controlled infusion of sufentanil combined with propofol phenol to induce and maintain anesthesia. TCIR group were given remifentanil combined with propofol to induce and maintain anesthesia. The hemodynamic changes during anesthesia, recovery time, extubation time, the dosage of propofol, postoperative Riker sedation and restlessness score (SAS) score, visual analog pain score were compared. Results Before anesthesia induction, there were no significant differences in the hemodynamic indexes between two groups (t=0.12,0.23,0.48,0.31,P>0.05). Compared with the TCIS group, the systolic pressure and diastolic pressure of TCIR group at the time of intubation were significantly lower(t=5.71, 8.63,P<0.05) while the systolic blood pressure, diastolic blood pressure and heart rate at the time of extubation were sig-nificantly higher (t=5.77,4.27,4.00,P<0.05). The differences of postoperative recovery time, extubation time and the dosage of propofol between two groups were not statistically significant (t=0.91,1.14,0.94,P<0.05). The SAS score and VAS score of TCIS group were significantly lower than that of the TCIR group(t=7.67,18.57,P<0.05). Conclusion Tar-get-controlled infusion of propofol combined with sufentanil for laparoscopic hernia ring ligation in perianesthesia has more stable hemodynamics and can be more effective in reducing postoperative agitation and pain in children which is better than remifentanil.
