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| 吸入和全凭静脉麻醉用于患儿纤维支气管镜检查效果的比较 |
| Comparison of the effects of inhalation and total intravenous anesthesia in children undergoing fiberoptic bronchoscopy |
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| DOI：10.12089/jca.2020.12.004 |
| 中文关键词: 七氟醚 丙泊酚 瑞芬太尼 纤维支气管镜 患儿 |
| 英文关键词: Sevoflurane Propofol Remifentanil Fiberoptic bronchoscopy Children |
| 基金项目:重大新药创制科技重大专项(2020ZX09201002)；温州医科大学附属第二医院 育英儿童医院临床研究基金项目(SAHoWMU-CR2017-03-208) |
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| 中文摘要: |
目的 比较吸入七氟醚保留自主呼吸和丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸两种麻醉管理方式用于患儿纤维支气管镜检查的安全性及有效性。
方法 选择行纤维支气管镜检查患儿72例，男37例，女35例，年龄2～4岁，BMI 12～19 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表法将患儿随机分为两组：吸入七氟醚保留自主呼吸组(吸入组)和丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸组(静脉组)，每组36例。吸入组给予七氟醚诱导，置入喉罩后持续吸入2.5%～3.0%七氟醚，保留自主呼吸维持麻醉。静脉组经外周静脉给予丙泊酚4 mg/kg+瑞芬太尼1 μg/kg缓慢推注诱导，置入喉罩后静脉泵入丙泊酚9 mg·kg-1·h-1、瑞芬太尼0.2 μg·kg-1·min-1，压力控制通气维持麻醉。记录麻醉诱导时间、诊疗时间、喉罩拔除时间和完全清醒时间。记录从开始给药到患儿完全清醒过程中低血压、心动过缓、低氧血症、镜检操作反应的发生情况以及镜检医师满意度评分。
结果 静脉组麻醉诱导时间明显短于吸入组［(1.8±0.3)min vs (3.1±0.8)min，P<0.05］，完全清醒时间明显短于吸入组［(11.7±4.6)min vs (13.6±5.1)min，P<0.05］，喉罩拔除时间明显长于吸入组［(5.6±1.2)min vs (0.5±0.2)min，P<0.01］，镜检操作反应发生率明显低于吸入组[14例（39%） vs 25例（69%），P<0.01]。两组诊疗时间、低血压、心动过缓以及低氧血症的发生率差异无统计学意义。静脉组镜检医师满意度评分明显高于吸入组［8.5(8.1～9.0)分vs 7.4(7.2～7.9)分，P<0.01］。
结论 患儿纤维支气管镜检查中，丙泊酚-瑞芬太尼静脉麻醉压力控制呼吸优于吸入七氟醚保留自主呼吸。 |
| 英文摘要: |
Objective To compare the safety and effectiveness of spontaneous ventilation with sevoflurane and pressure-controlled ventilation with propofol-remifentanil combined with intravenous anesthesia in pediatric fiberoptic bronchoscopy.
Methods Seventy-two children undergoing fiberoptic bronchoscopy, 37 males and 35 females, aged 2-4 years, BMI 12-19 kg/m2, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: spontaneous ventilation with sevoflurane group (inhalation group) and pressure-controlled ventilation with combined propofol-remifentanil group (venous group), 36 cases in each group. Induction was carried out with sevoflurane in the inhalation group, and 2.5%-3% sevoflurane was retained for spontaneous ventilation to maintain anesthesia after laryngeal mask insertion. The venous group was administered with intravenous propofol 4 mg/kg and remifentanil 1 μg/kg. After insertion of the laryngeal mask, propofol 9 mg·kg-1·h-1 and remifentanil 0.2 μg·kg-1·min-1 were given and pressure-controlled ventilation was maintained to keep anesthesia. The incidence of hypotension, bradycardia, hypoxemia, and other adverse reaction were recorded from the beginning of administration to the state of complete wakefulness. Anaesthesia induction time, diagnosis and treatment time, laryngeal mask removal time, completely awake time, and the satisfaction score of the bronchoscopy physician were recorded.
Results Compared with the inhalation group, the induction was faster in the venous group [(1.8±0.3) min vs (3.1±0.8) min, P < 0.05], completely awake time was earlier in the venous group [(11.7±4.6) min vs (13.6±5.1) min, P < 0.05], the incidence of adverse reactions were lower in the venous group [14(39%) vs 25(69%), P<0.01], while the time of removing the laryngeal mask was longer in the venous group [(5.6±1.2) min vs (0.5±0.2) min, P < 0.01]. There was no significant difference in the treatment time, the incidence of hypotension, hypoxemia, and bradycardia between the two groups. Bronchoscopy physician satisfaction score was higher in the venous group than in the inhalation group [8.5 (8.1-9.0) scores vs 7.4 (7.2-7.9) scores, P < 0.01].
Conclusion Pressure-controlled ventilation combined with propofol-remifentanil is superior to spontaneous ventilation with sevoflurane in pediatric fiberoptic bronchoscopy. |
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