两种全凭静脉麻醉方法在小儿鼻泪道手术中的应用

发布时间：2018-05-08 13:55

本文选题：全凭静脉麻醉 + 小儿　；参考：《武警后勤学院学报(医学版)》2016年02期

【摘要】：【目的】观察两种全凭静脉麻醉方法在小儿鼻泪道手术的临床应用效果。【方法】选100例行内窥镜下鼻泪道手术的小儿(1.5~6岁),依据美国麻醉医师协会(american society of anesthesiologists,ASA)分级标准随机分为A、B两组(n=50),A组诱导前静脉泵注右旋美托咪啶[初始量0.6μg·(kg·h)-1,10 min],术中靶控静脉泵注右旋美托咪啶0.5μg·(kg·h)-1及雷米芬太尼,B组常规诱导后靶控静脉泵注丙泊酚和雷米芬太尼,术毕前5 min停用麻醉药物。术中根据脑电双频谱指数(bispectral index,BIS)调整麻醉药用量。记录和测定麻醉诱导前(T0)、气管插管即刻(T1)、置入鼻内窥镜时(T2)、拔管后1 min(T3)、3 min(T4)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、去甲肾上腺素(norepinephrine,NE)、肾上腺素(epinephrine,E)的变化和术中雷米芬太尼用量、麻醉恢复时间及不良反应。【结果】与B组相比,A组T0、T1、T2、T3时MAP、HR、血浆NE、E浓度下降明显(P0.05);与T0相比,B组T1、T3时HR、MAP及血浆NE和E浓度均显著升高(P0.05);雷米芬太尼总用药量A组显著少于B组(P0.05)。A组术后拔管后气道痉挛、术后头疼、呼吸抑制、呛咳躁动发生率也明显低于B组(P0.05)。【结论】右旋美托咪啶复合雷米芬太尼的全凭静脉麻醉方法可减轻小儿鼻泪道手术应激反应及术后不良反应、减少麻醉药用量,但不延长麻醉苏醒时间。
[Abstract]:[objective] to observe the clinical effect of two total intravenous anaesthesia methods in pediatric nasolacrimal duct surgery. [methods] 100 children undergoing endoscopic nasolacrimal duct surgery were enrolled in this study. According to the score of American society of the anesthesiologists ASAs, 100 children with nasolacrimal duct surgery underwent endoscopic nasolacrimal surgery. The first grade standard was randomly divided into two groups: group A (n = 50) received dexmetidine before induction [initial dose was 0.6 渭 g / kg / h ~ (-1) 10 min], target controlled intravenous injection of dexmetidine 0.5 渭 g / kg / h ~ (-1) and remifentanil group B (n = 10) were treated with propofol and remifentanil after conventional induction. The anesthetic was stopped 5 min before the end of operation. The dosage of anesthetic was adjusted according to bispectral index (BIS). The mean arterial pressureMAPP, heart rate, norepinephrine, epinephrine (epinephrine) and the dosage of ramifentanil were recorded and measured before anesthesia induction, immediately after endotracheal intubation, 1 min after extubation and 1 min after extubation. Anesthesia recovery time and adverse reactions. [results] compared with group B, MAPHRs of T0 and T1 and T2T3 of group A decreased significantly (P 0.05), HRMAP, NE and E of plasma of group B were significantly higher than those of group T0; total dosage of remifentanil was significantly increased in group A. The airway spasm after extubation in group B was significantly less than that in group B (P 0.05). The incidence of headache, respiratory inhibition, cough and restlessness in group B was significantly lower than that in group B. [conclusion] the total intravenous anesthesia of dexmetidine combined with remifentanil can relieve the stress reaction and postoperative adverse reactions of nasolacrimal duct surgery in children. Reduce the amount of anesthetic, but do not prolong the anaesthesia recovery time.
【作者单位】：沈阳市第四人民医院麻醉科;中国医科大学附属盛京医院麻醉科;
【分类号】：R726.1

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