丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术的研究

中国临床药理学与治疗学 ›› 2010, Vol. 15 ›› Issue (11): 1279-1283.

丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术的研究

刘华程, 李军, 孔微微, 上官王宁, 蔡明阳, 连庆泉

温州医学院附属二院麻醉科,温州 325027,浙江

收稿日期:2010-10-08 修回日期:2010-10-27 出版日期:2010-11-26 发布日期:2020-09-16
通讯作者: 连庆泉,男,博士,教授,博士生导师,主要研究方向:小儿麻醉和麻醉药理学。Tel: 13957713889 E-mail: lianqingquan@yahoo.com.cn
作者简介:刘华程,男,医学硕士,研究方向:小儿麻醉与静脉麻醉。Tel: 13957770577 E-mail: huachengliu@163.com
基金资助:
卫生部科学研究基金-浙江省医药卫生重大科技计划(WKJ2010-2-017);浙江省医药卫生科学研究基金计划(2009A150);温州市科技计划项目(Y20090412)

Study on total intravenous anesthesia with target-controlled infusion of propofol and continuous intravenous infusion of remifentanil in pediatric short duration surgery

LIU Hua-cheng, LI Jun, KONG Wei-wei, SHANGGUAN Wang-ning, CAI Ming-yang, LIAN Qing-quan

Department of Anesthesiology, the 2nd Affiliated Hospital of Wenzhou Medical College,Wenzhou 325027, Zhejiang, China

Received:2010-10-08 Revised:2010-10-27 Online:2010-11-26 Published:2020-09-16

摘要/Abstract

摘要： 目的: 研究新型丙泊酚靶控输注联合瑞芬太尼全凭静脉麻醉用于小儿短小手术的有效性和安全性,并与吸入麻醉作比较。方法: 择期行短小手术患儿60例,年龄3~9岁,随机分为2组,每组30例。静脉组:应用新型小儿丙泊酚系统血浆 3 μg/mL 靶控输注联合瑞芬太尼持续静脉输注 0.2~0.3 μg／(kg·min)以维持麻醉;吸入组:对照组,采用持续吸入3%~4%七氟烷维持麻醉;均置入喉罩行气道管理。于麻醉前(T₀)、诱导毕(T₁)、喉罩置入即刻(T₂)、切皮(T₃)、切皮后 10 min (T₄)及喉罩拔除即刻 (T₅)等时点记录心率(HR)、平均动脉压(MAP)、脑电双频谱指数(BIS) 。术后记录麻醉苏醒时间、清醒程度(OAA/S评分)及不良反应。结果: T₂~T₅时点HR、MAP吸入组大于静脉组(P<0.05 或 0.01);T₁~T₅时点HR、MAP组内比较,静脉组差异无统计学意义,吸入组差异有统计学意义(P<0.05)。与吸入组比较,静脉组苏醒时间降低、停药后 10 min 的OAA/S评分增高、术后烦躁及恶心呕吐例数减少、麻醉效果满意例数增高(P<0.05)。结论: 丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术,麻醉过程平稳, 术中血流动力学稳定,应激反应较小,不良反应较少,术后恢复质量较好,是一种较理想的麻醉方法。

关键词: 丙泊酚, 瑞芬太尼, 靶控输注, 小儿

Abstract: AIM: To evaluate the anesthetic effect and the safety of total intravenous anesthesia (TIVA) with target-controlled infusion of propofol and continuous intravenous infusion of remifentanil in pediatric short duration surgery: comparison with total inhalational anesthesia. METHODS: 60 pediatric cases suffered from short duration elective surgery were randomly divided into two groups, 30 cases each group. The intravenous group and inhalation group (control group). Patients in the intravenous group were anesthetized by TIVA with target controlled infusion of propofol (3 μg/mL) and remifentanil continuous intravenous infusion (0.2-0.3 μg·kg^-1·min^-1). Patients in the control group were given inhalation of 3%-4% sevoflurane. The heart rate(HR), mean arterial blood pressure(MAP) and spectral index(BIS) of the patients were recorded at time points: before induction (T₀), after induction (T₁), LMA insertion (T₂), skin incision(T₃), 10 mins after skin incision (T₄), LMA extraction(T₅). Recording the awakening time, degree of vigilance (OAA/S scores) and postoperative adverse events. RESULTS: The HR and MAP of T₂-T₅ in control group were significantly higher than those in intravenous group (P<0.05 or 0.01). There were significantly different of T₁-T₅ values of HR and MAP in control group(P<0.05), but not in intravenous group (P>0.05). The awakening time in intravenous group was significantly shorter than that in control group(P<0.05). The OAA/S scores 10 mins after drug discontinuance were higher in intravenous group than those in control group (P<0.05). The occurrences of postoperative nausea, vomiting and restlessness were more frequently observed in patients in the control group than those in intravenous group(P<0.05). The anesthesia satisfactory ratio was higher in intravenous group than that in control group. CONCLUSION: TIVA with target-controlled infusion of profofol and continuous intravenous infusion of remifentanil displays stability in hemodynamics, less stress, rapid recovery, less complications, better clinical results in pediatric short duration surgery.

Key words: Propofol, Remifentanil, Target controlled infusion, Child

中图分类号:

R614

刘华程, 李军, 孔微微, 上官王宁, 蔡明阳, 连庆泉. 丙泊酚靶控输注联合瑞芬太尼静脉输注麻醉用于小儿短小手术的研究[J]. 中国临床药理学与治疗学, 2010, 15(11): 1279-1283.

LIU Hua-cheng, LI Jun, KONG Wei-wei, SHANGGUAN Wang-ning, CAI Ming-yang, LIAN Qing-quan. Study on total intravenous anesthesia with target-controlled infusion of propofol and continuous intravenous infusion of remifentanil in pediatric short duration surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(11): 1279-1283.

参考文献

[1] Schüttler J, Ihmsen H. Population pharmacokinetics of propofol: a multicenter study[J]. Anesthesiology,2000, 92(3): 727-738.
[2] Davis PJ, Cladis FP. The use of ultra-short-acting opioids in paediatric anaesthesia[J]. Clin Pharmacokinet, 2005, 44(8): 787-796.
[3] Shangguan WN, Lian QQ, Aarons L, et al. Pharmacokinetics of a single bolus of propofol in different age of Chinese children[J]. Anesthesiology, 2006, 104(1): 27-32.
[4] 王若松.效应室靶控输注在静脉麻醉中的应用[J]. 国外医学.麻醉学与复苏分册, 2000,21(1): 7-9.
[5] 连庆泉, 上官王宁, 王增寿, 等. 不同年龄患儿异丙酚的药代动力学[J]. 中华麻醉学杂志, 2005, 25(6): 425-427.
[6] Marsh B, White M, Morton M, et al. Pharmacokinetic model driven infusion of propofol in children[J]. Br J Anaesth, 1991, 67(1): 41-48.
[7] 连庆泉, 刘华程, 上官王宁, 等. 小儿异丙酚靶控输注系统准确性的评价[J]. 中华麻醉学杂志, 2006, 26(2): 118-121.
[8] 刘华程, 宋海龙, 黄茜茜, 等. 我国小儿丙泊酚靶控输注系统在小儿短小手术中的应用[J]. 中华医学杂志, 2010, 90(7): 458-461.
[9] Mertens MJ, Olofsen E, Engbers FH, et al. Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions[J]. Anesthesiology, 2003, 99(2): 347-359.
[10] Kerssens C, Klein J, Woerd A, et al. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index[J]. Anesth Analg, 2001, 92(5): 1210-1214.
[11] Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit[J]. Anesth Analg, 2003, 96(6): 1625-1630.
[12] Kalrsen KL, Pesrson E, Wennberg E, et al. Anaesthesia recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia[J]. Acta Anaesthesiol Scand, 2000, 44(4): 489-493.

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