摘要
目的探讨瑞芬太尼和丙泊酚效应室靶控输注(TCI)联合喉罩通气在小儿先天性心脏病介入手术麻醉中的可行性和安全性。方法选择ASAⅠ或Ⅱ级,年龄3～9岁拟择期行介入治疗的先天性心脏病患儿236例,随机分为喉罩组(LMA组,n=120)和气管内插管组(ET组,n=116)。麻醉诱导TCI丙泊酚和瑞芬太尼(效应室浓度分别为4.0μg/ml和4.0ng/ml),ET组同时给予单次剂量的维库溴铵0.15mg/kg,LMA组不使用肌松药。麻醉维持TCI丙泊酚效应室浓度2.5～4.0μg/ml、瑞芬太尼效应室浓度4.0ng/ml,术中调节丙泊酚浓度使听觉诱发电位指数(AAI)维持在25～30。于诱导前、插管(喉罩)时、术中、插管(喉罩)时监测SBP、HR、SpO2、PETCO2和术中AAI,记录术中患儿体动、停药至拔除导管(喉罩)时间、拔管(喉罩)时呛咳、烦躁,拔管后患儿体动和配合情况。结果插管(喉罩)时和拔管(喉罩)时ET组BP明显高于、HR快于诱导前和LMA组(P<0.01);两组术中BP低于、HR慢于诱导前,但差异无统计学意义。ET组拔管时间明显长于LMA组(P<0.01);ET组拔管时呛咳、烦躁发生率明显高于LMA组(P<0.01)。两组术中均未出现体动。结论丙泊酚和瑞芬太尼靶控输注联合喉罩全身麻醉在先心病介入治疗麻醉中具有循环稳定、苏醒迅速完全,呛咳和躁动发生率低等特点,麻醉效果良好,安全可靠。
Objective To observe the feasibility and safety of propofol and remifentanil anesthesia under laryngeal mask airway（LMA） in interventional therapy of congenital heart disease in children. Methods Two hundred and thirty-six ASA I or ]I , 3-9 years old congenital heart disease children scheduled for interventional therapies were randomly allocated to two groups： laryngeal mask airway group （group LMA, n=120） and endotracheal tube group（group ET, n= 116）. All patients were induced with propofol TCI 4. 0 gg/ml, remifentanil 4.0 ng/ml（effect-site concentration）. Group ET also received vecuronium 0. 15 mg/kg but not for group LMA. Anesthesia was maintained with propofol TCI 2.5-4.0μg/ml, remifentanil 4.0 ng/ml （effect-site concentration）. During surgery, the target propofol effect-site concentration was adjusted to maintain an auditory evoked potentials index （AAl） value between 25 and 30, while the target remifentanil effect-site concentration was maintain 4. 0 ng/mL HR, SBP, SpO2, PFrCO2 and AAI were recorded. Intraoperative body movements, vasoactive drug usage, extubation time or the time to remove LMA, incidence of coughing and agitation during recovery period were also recorded. Results BP and HR in group ET after intubation and after extubation（laryngeal mask） were significantly higher than baseline and those of group LMA （P〈0.01）. BP and HR decreased mildly but without significance when compared with baseline. The extubation time in group ET was longer than that of group IrMA （P〈0.01）. The incidence of emergence coughing and agitation was significantly lower in the group LMA than the group ET （P〈 0.01）. No body movement was found in either group. Conclusion TCI based propofol and remifentanil anesthesia under LMA in interventional therapy of congenital heart disease in children is a perfect and safe anesthesia method with stable hemodynamics, quick recovery, low incidence of emergence agitation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第10期961-963,共3页
Journal of Clinical Anesthesiology
关键词
介入治疗
先天性心脏病
全身麻醉
靶控输注
喉罩
丙泊酚
瑞芬太尼
Interventional therapy
Congenital heart disease
General anesthesia
Targetcontrolled infusion
Laryngeal mask airway
Propofol
Remifentanil
