CAJ | 학술논문

目的：探讨七氟烷复合瑞芬太尼麻醉在小儿短小手术中的应用效果。方法：将40例择期行短小手术患儿随机分为七氟烷组（ S组）和七氟烷复合瑞芬太尼组（ SR组），每组20例，术前均予七氟烷吸入后静脉注射咪达唑仑0.1 mg/kg、阿托品0.01 mg/kg、芬太尼3μg /kg，行气管内插管机械通气；麻醉维持，SR组采用瑞芬太尼6μg/kg·h持续静脉泵注，复合七氟烷吸入；S组仅七氟烷吸入，手术开始追加芬太尼2μg/kg，术毕拔除气管导管观察呼吸无异常送入麻醉后监测治疗室（ PACU）；记录两组患儿诱导前（ T0），插管时（ T1），插管后5 min （T2）、手术开始（T3）、手术开始后5 min（T4）、手术结束（T5）、拔除气管导管时（T6）及拔管后5 min（T7）的心率（ HR）、平均动脉压（ MAP）、脉搏氧饱和度（ SpO2）变化，比较两组患儿术后拔管时间、苏醒时间和拔管后呼吸道事件发生情况，对患儿进行苏醒期躁动评分（ PAED）和疼痛评分（ FLACC）。结果：两组患儿麻醉过程平稳，气管插管、拔管时的血流动力学变化比较，差异无统计学意义（ P＞0.05）；拔管时间、苏醒时间SR组比S组短，差异有统计学意义（ P＜0.05）；术后患儿PAED评分，SR组术后躁动低于S组，差异有统计学意义（ P＜0.05），FLACC评分比较无差异，SR组术中七氟烷用药量少于S组（ P＜0.05）。结论：七氟烷复合瑞芬太尼麻醉在小儿短小手术中易于维持，苏醒快，术后躁动发生率低。
목적：탐토칠불완복합서분태니마취재소인단소수술중적응용효과。방법：장40례택기행단소수술환인수궤분위칠불완조（ S조）화칠불완복합서분태니조（ SR조），매조20례，술전균여칠불완흡입후정맥주사미체서륜0.1 mg/kg、아탁품0.01 mg/kg、분태니3μg /kg，행기관내삽관궤계통기；마취유지，SR조채용서분태니6μg/kg·h지속정맥빙주，복합칠불완흡입；S조부칠불완흡입，수술개시추가분태니2μg/kg，술필발제기관도관관찰호흡무이상송입마취후감측치료실（ PACU）；기록량조환인유도전（ T0），삽관시（ T1），삽관후5 min （T2）、수술개시（T3）、수술개시후5 min（T4）、수술결속（T5）、발제기관도관시（T6）급발관후5 min（T7）적심솔（ HR）、평균동맥압（ MAP）、맥박양포화도（ SpO2）변화，비교량조환인술후발관시간、소성시간화발관후호흡도사건발생정황，대환인진행소성기조동평분（ PAED）화동통평분（ FLACC）。결과：량조환인마취과정평은，기관삽관、발관시적혈류동역학변화비교，차이무통계학의의（ P＞0.05）；발관시간、소성시간SR조비S조단，차이유통계학의의（ P＜0.05）；술후환인PAED평분，SR조술후조동저우S조，차이유통계학의의（ P＜0.05），FLACC평분비교무차이，SR조술중칠불완용약량소우S조（ P＜0.05）。결론：칠불완복합서분태니마취재소인단소수술중역우유지，소성쾌，술후조동발생솔저。
Objective:To investigate the effect of applying sevoflurane combined with remifentanil anesthesia in mini-pediatric surgery. Methods:Forty children were randomly divided into sevoflurane group(S group)and sevoflurane combined with remifentanil group(SR group)with equal number. All patients received midazolam 0. 1 mg/kg,atropine 0. 01 mg/kg,fentanyl 3 μg/kg after sevoflurane inhalation,endotracheal intubated and mechanical ventilated. For maintaining anesthesia effect,the SR group received 6 μg/( kg·h)fentanyl continuous intravenous injection combined with sevoflurane inhalation;Group S received only sevoflurane inhalation and at the beginning of surgery received 2μg/kg fentanyl. After surgery,the endotracheal tube was removed and the children were transferred to postanesthesia care unit( PACU)after detecting no expiratory dyspnea. Change of HR,MAP and SpO2 were recorded before the induction of anesthesia( T0 ),during intubation( T1 ),5 minutes after intubation( T2 ),at the beginning of surgery( T3 ),5 minutes after surgery( T4 ),the end of surgery (T5),removing the endotracheal tube(T6)and 5 minutes after extubation(T7);comparing the extuba-tion time,awakening time and observed the respiratory events after extubation. Pediatric Anesthesia Emer-gence Delirium( PAED)scores and face,legs,activity,cry,consolability scale( FLACC)was made.Results:The difference of endotracheal intubation and extubation hemodynamic change was not statisti-cally significant in two groups( P>0 . 05 ). The extubation and awakening time of group SR was shor-ter than group S,the difference was statistically significant(P<0. 05). The PAED scale of group SR was lower than group S,the difference was statistically significant(P<0. 05). No significant difference was found in FLACC between the two groups(P>0. 05),the dosage of sevoflurane in SR group was lower than S group(P<0. 05). Conclusion:Sevoflurane combined with remifentanil anesthesia is easy to con-trol,decrease the awakening time and the incidence of emergence agitation in mini-pediatric surgery.