本文選題：疝氣 + 七氟烷　； 參考：《中國(guó)藥房》2017年11期

【摘要】：目的:探討七氟烷吸入麻醉與異丙酚靜脈麻醉對(duì)疝氣手術(shù)患兒血流動(dòng)力學(xué)、應(yīng)激反應(yīng)及麻醉效果的影響。方法:選取2011年5月-2015年9月于湖北省第三人民醫(yī)院接受疝氣手術(shù)的86例患兒為研究對(duì)象,采用隨機(jī)數(shù)字表法分為試驗(yàn)組和對(duì)照組,各43例。試驗(yàn)組患兒給予注射用鹽酸替羅非班0.4μg/(kg·min),ivgtt,注射用苯磺順阿曲庫(kù)銨0.1 mg/kg+枸櫞酸芬太尼注射液1.0μg/kg,iv,進(jìn)行麻醉誘導(dǎo);吸入用七氟烷2%~3%進(jìn)行麻醉維持,必要時(shí)追加枸櫞酸芬太尼注射液0.5μg/kg,iv。對(duì)照組患兒給予異丙酚乳狀注射液3 mg/kg+注射用苯磺酸阿曲庫(kù)銨0.1 mg/kg+枸櫞酸芬太尼注射液1.0μg/kg,iv,進(jìn)行麻醉誘導(dǎo);丙泊酚注射液3 mg/(kg·h)微泵注入進(jìn)行麻醉維持,必要時(shí)追加枸櫞酸芬太尼注射液0.5μg/kg,iv。觀察兩組患兒麻醉起效時(shí)間、血流動(dòng)力學(xué)指標(biāo)[收縮壓(SBP)、舒張壓(DBP)和心率(HR)]、應(yīng)激反應(yīng)指標(biāo)[去甲腎上腺素(NE)、腎上腺素(E)和腎素(R)]、蘇醒情況,并記錄不良反應(yīng)發(fā)生情況。結(jié)果:試驗(yàn)組患兒麻醉起效時(shí)間為(3.82±0.45)min,明顯短于對(duì)照組的(5.13±0.74)min,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。麻醉誘導(dǎo)前,兩組患兒SBP、DBP、HR和血清NE、E、R水平比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。切皮即刻、切皮后5 min、切皮后10 min時(shí),兩組患兒SBP、DBP、HR水平均明顯高于麻醉誘導(dǎo)前,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);切皮即刻、切皮后5 min時(shí),試驗(yàn)組上述指標(biāo)明顯低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。切皮即刻時(shí),兩組患兒血清NE、E、R水平均較麻醉誘導(dǎo)前明顯升高,但試驗(yàn)組明顯低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。試驗(yàn)組患兒術(shù)后的睜眼時(shí)間、清醒時(shí)間、定向力恢復(fù)時(shí)間均明顯短于對(duì)照組,蘇醒期躁動(dòng)量化評(píng)分明顯低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。試驗(yàn)組患兒不良反應(yīng)發(fā)生率(0)明顯低于對(duì)照組(11.6%),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:七氟烷吸入麻醉較異丙酚靜脈麻醉對(duì)疝氣手術(shù)患兒的血流動(dòng)力學(xué)指標(biāo)影響小,有助于緩解應(yīng)激反應(yīng)、促進(jìn)術(shù)后蘇醒,且安全性較好。
[Abstract]:Objective: to investigate the effects of sevoflurane inhalation anesthesia and propofol intravenous anesthesia on hemodynamics, stress response and anesthetic effect in children with hernia. Methods: 86 children undergoing hernia operation in Hubei third people's Hospital from May 2011 to September 2015 were selected and randomly divided into two groups: experimental group (n = 43) and control group (n = 43). In the experimental group, tirofiban hydrochloride (0.4 渭 g/(kg) was given intravenously, and fentanyl citrate (1.0 渭 g / kg iv) was administered to fentanyl citrate (0.1 渭 g / kg) for injection, sevoflurane (2%) was inhaled to maintain the anesthesia, and fentanyl citrate (0.5 渭 g / kg) was added as necessary. Children in the control group were given propofol emulsion injection for 3 mg/kg and fentanyl citrate injection 1.0 渭 g / kg / kg iv for injection of atracurium benzenesulfonate for 3 mg/kg, and propofol injection for 3 mg/(kg / h for maintenance of anesthesia. Fentanyl citrate injection 0.5 渭 g / kg iv. The onset time of anesthesia, hemodynamic parameters (SBP, DBP, HRH), stress response (NE, E) and renin (R) were observed, and adverse reactions were recorded. Results: the onset time of anesthesia in the test group was 3.82 鹵0.45 min, which was significantly shorter than that in the control group (5.13 鹵0.74 min, P 0.05). Before anesthesia induction, there was no significant difference between the two groups in the levels of SBP, DBP, HR and serum neutrol (P 0.05). Immediately after skin incision, 5 minutes after skin incision and 10 min after skin incision, the levels of SBPnDBPHR in both groups were significantly higher than those before anesthesia induction, the difference was statistically significant (P 0.05), and the above indexes in the experimental group were significantly lower than those in the control group immediately after skin incision and 5 min after skin incision. The difference was statistically significant (P 0.05). Immediately after skin incision, the serum NEP level in both groups was significantly higher than that before anesthesia induction, but the level in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). The time of opening eyes, waking time and recovery time of orientation in the test group were significantly shorter than those in the control group, and the score of restlessness in the recovery period was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). The incidence of adverse reactions in the test group was significantly lower than that in the control group (P 0.05). Conclusion: sevoflurane inhalation anesthesia has less effect on hemodynamics than propofol intravenous anesthesia, which is helpful to relieve stress reaction and promote postoperative recovery.
【作者單位】： 湖北省第三人民醫(yī)院麻醉科;武漢市東西湖區(qū)婦幼保健院B超室;
【分類號(hào)】：R614

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