瑞芬太尼复合异丙酚麻醉应用于婴幼儿腹腔镜手术探究.docVIP

瑞芬太尼复合异丙酚麻醉应用于婴幼儿腹腔镜手术探究 　 作者：廖锡强， 赵国进， 黄锦联， 李卫明 【关键词】 腹腔镜手术 摘 要：目的：观察泵注瑞芬太尼复合异丙酚静脉麻醉在婴幼儿腹腔镜手术中应用的效果。方法：3岁以下行腹腔镜斜疝修补术病人60例，随机分两组，A组(n=30)，吸入异氟醚进行气管内麻醉，B组(n=30)，泵注瑞芬太尼复合异丙酚静脉麻醉，观察麻醉过程中血压心率，停药后自主呼吸恢复、呼之睁眼及拔管时间，术后止痛药需求时间，麻醉后不良反应。结果： ①A组病人在人工气腹及气管拔管时血压及心率显著升高，B组病人麻醉后各时段均表现为显著的心率及血压下降。②B组自主呼吸恢复时间、呼之睁眼时间、拔管时间、术后离床时间均较A组提前22%～47%不等，有显著差异。③B组术后对止痛药物需求早于A组。④A组术后呕吐、低血氧高于B组。结论：与常规吸入全麻行婴幼儿腹腔镜斜疝修补术比较，泵注瑞芬太尼复合异丙酚静脉麻醉效果更确切，苏醒快而且苏醒质量好。由于半衰期短，需及时开始术后镇痛。 　　关键词： 瑞芬太尼； 异丙酚； 婴幼儿； 腹腔镜手术 　　Investigation of Remifentanil and Propofol in Anesthesia care of Infant Laparoscopic Operation 　　　Abstract： Objective： To observe the effect of remifentanil and propofol in anesthesia care of infant laparoscopic operation.Method： 60 patients younger than 3 years old undergoing laparoscopic operation were divided randomly into two groups:intratracheal anesthesia with isoflusine(A group) and intravenous anesthesia with remifentanil and propofol(B group).The blood pressure(BP) and heart rate(HR) during anesthesia,the time of respiratory recovery and extubation after anesthesia ,the time of using painkiller after operation,the side effect causing by anesthesia were observed. Results： ①The BP and HR increased obviously during artificial pneumoperitoneum and extubation in group A, the BP ang HR decreased during anesthesia in group B. ②The time of respiratory recovery and extubation,the time of leaving bed after operation shortened 22～47% in group B. ③The time needing painkiller was earlier in group B than group A. ④The rate of vomitus and hypoxemia was higher in group A than group B. Conclusion： Remifentanil and propofol in anesthesia care of infant laparoscopic herniorrhaphy give more efficiant anesthesia and better recovery than intratracheal anesthesia,painkiller must be used on time because of the short half-life time. 　　Key words： Remifentanil; Propofol; Infant; Laparoscopic operation 　　瑞芬太尼(Remifentanil)是一种药效强、起效快、副作用少的新型阿片受体激动剂，泵注瑞芬太尼复合异丙酚(Propofol)应用于成人手术麻醉具有良好效果而成为众多麻醉医生喜欢的一种麻醉方法［1,2］，但在婴幼儿腹腔镜手术麻醉中