CAJ | 학술논문

目的：探讨瑞芬太尼联合丙泊酚联合靶控输注在小儿喉罩麻醉中应用的安全性和可行性。方法选择择期全麻下行腹部手术患儿116例，随机分为瑞芬太尼联合丙泊酚组(A组)和单纯丙泊酚组（B组），每组58例。两组患儿分别静脉输注瑞芬太尼1μg/kg和等容量生理盐水30 s后静注丙泊酚，按照序贯法给予患儿相应的丙泊酚剂量，丙泊酚靶浓度为2.5 mg/kg，后行喉罩插入。观察并记录麻醉诱导前(T0)、瑞芬太尼给药后2 min (T1)、喉罩成功插入即刻(T2)、切皮即刻(T3)、切皮后5 min (T4)和喉罩拔出即刻(T5)患儿的血压(HR)、平均动脉压(MAP)、呼气末二氧化碳分压(PETCO2)和脑电双频谱指数(BIS)以及记录喉罩重新置入的人数、置入时间、术中不良反应。结果与T0时刻比较，B组患儿的HR、MAP在T2、T3、T5时刻均升高(P<0.01)，而A组患儿在各时点HR、MAP差异无统计学意义(P>0.05)。与B组患儿比较，A组患儿的HR、MAP在T2、T3、T5时刻降低(P<0.01)。两组患儿PETCO2在T1、T2、T3、T4时刻均高于T0(P<0.01)。与A组患儿比较，B组患儿BIS在T1~T5时刻均升高(P<0.01)，两组患儿在T1~T5时刻BIS均低于T0(P<0.01)。A组的患儿喉罩插入后出现咳嗽/作呕、肢体动的例数少于B组(P<0.05)。结论瑞芬太尼联合丙泊酚靶控输注的麻醉诱导方法能够为患儿喉罩插入提供较好的麻醉条件和较低的不良反应发生率。
목적：탐토서분태니연합병박분연합파공수주재소인후조마취중응용적안전성화가행성。방법선택택기전마하행복부수술환인116례，수궤분위서분태니연합병박분조(A조)화단순병박분조（B조），매조58례。량조환인분별정맥수주서분태니1μg/kg화등용량생리염수30 s후정주병박분，안조서관법급여환인상응적병박분제량，병박분파농도위2.5 mg/kg，후행후조삽입。관찰병기록마취유도전(T0)、서분태니급약후2 min (T1)、후조성공삽입즉각(T2)、절피즉각(T3)、절피후5 min (T4)화후조발출즉각(T5)환인적혈압(HR)、평균동맥압(MAP)、호기말이양화탄분압(PETCO2)화뇌전쌍빈보지수(BIS)이급기록후조중신치입적인수、치입시간、술중불량반응。결과여T0시각비교，B조환인적HR、MAP재T2、T3、T5시각균승고(P<0.01)，이A조환인재각시점HR、MAP차이무통계학의의(P>0.05)。여B조환인비교，A조환인적HR、MAP재T2、T3、T5시각강저(P<0.01)。량조환인PETCO2재T1、T2、T3、T4시각균고우T0(P<0.01)。여A조환인비교，B조환인BIS재T1~T5시각균승고(P<0.01)，량조환인재T1~T5시각BIS균저우T0(P<0.01)。A조적환인후조삽입후출현해수/작구、지체동적례수소우B조(P<0.05)。결론서분태니연합병박분파공수주적마취유도방법능구위환인후조삽입제공교호적마취조건화교저적불량반응발생솔。
Objective To study the feasibility and safety of target controlled infusion for remifentanil plus propofol in pediatric surgery with laryngeal mask airway anesthesia. Methods A total of 116 pediatric patients under-went elective abdominal surgery were randomly divided into two groups (58 cases in each group):remifentanil plus propofol group (group A) and propofol plus saline group (group B). Thirty seconds after the injection of 1μg/kg remi-fentanil or saline, propofol was given i.v. followed by insertion of laryngeal mask 90 s. The initial target plasma con-centrations of propofol were 2.5 mg/kg. HR, MAP, PETCO2 and BIS were recorded before anesthesia induction (T0), 2 min after remifentanil treatment (T1), at the time of inserting laryngeal mask successfully (T2) and cutting the skin (T3), 5 min after cutting the skin (T4), as well as at the time of pulling out laryngeal mask (T5). The number of reinsert of la-ryngeal mask, insert time and adverse events were a1so recorded. Results Both HR, MAP increased at T2, T3,T5 in group B compared with T0 (P<0.05), but there was no difference of HR, MAP in group B at different times (P>0.05). Compared with group B, HR, MAP decreased in group A at T2, T3, T5 (P<0.05). Both groups of PETCO2 at T1, T2, T3, T4 were higher than at T0 (P<0.05). Compared with group A, BIS in group B increased at T1~T5 (P<0.05) and BIS in two groups at T1~T5 were lower than T0 (P<0.05). There were more adverse reactions (coughing, vomiting, arm and hand movements) in group B than group A (P<0.05). Conclusion Target controlled infusion for remifentanil plus propo-fol can provide better condition of laryngeal mask airway anesthesia in pediatric patients with low incidence of ad-verse reactions.