文章摘要
阿芬太尼与芬太尼用于患儿喉罩全麻下上颌多生牙拔除术的比较
Comparison of afentanyl and fentanyl on maxillary supernumerary teeth extraction under general anesthesia with laryngeal mask in children
  
DOI：10.12089/jca.2024.11.009
中文关键词: 阿芬太尼  芬太尼  多生牙拔除术  舒适化口腔治疗  喉罩  全麻
英文关键词: Alfentanil  Fentanyl  Extraction of supernumerary teeth  Comfortable oral treatment  Laryngeal mask  General anesthesia
基金项目:浙江省卫生厅课题项目资助（2022KY208）
作者单位E-mail
潘乐周 325000,温州医科大学口腔医学院·附属口腔医院手术麻醉中心  
刘若海 325000,温州医科大学口腔医学院·附属口腔医院手术麻醉中心  
上官王宁 温州医科大学附属第二医院 育英儿童医院麻醉与围术期医学科 sgwning@163.com 
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中文摘要:
      
目的： 比较阿芬太尼与芬太尼用于患儿喉罩全麻下上颌多生牙拔除术的应用效果。
方法： 选择全麻下行上颌多生牙拔除术的患儿58例，男43例，女15例，年龄5～12岁，体重15～50 kg，ASA Ⅰ或Ⅱ级，预计手术时间<30 min。采用随机数字表法将患儿分为两组：阿芬太尼组（A组）和芬太尼组（C组），每组29例。A组给予阿芬太尼10 μg/kg，再给予丙泊酚3 mg/kg行麻醉诱导；C组给予芬太尼1.5 μg/kg，再给予丙泊酚3 mg/kg行麻醉诱导。两组麻醉维持阶段均吸入七氟醚1.0 MAC。记录麻醉诱导前（T0）、喉罩置入前（T1）、牙龈切开时（T2）、手术结束时（T3）的HR和MAP。记录喉罩拔除时间、苏醒时间、自主呼吸恢复例数、围术期总不良反应发生例数、术者及患儿家属的满意度评分。
结果： 与C组比较，A组T3时HR明显增快、喉罩拔除时间明显缩短、自主呼吸恢复率明显升高、围术期总不良反应发生率明显降低（P＜0.05）。两组苏醒时间、术者及患儿家属的满意度评分差异无统计学意义。
结论： 与芬太尼比较，阿芬太尼用于喉罩全麻下上颌多生牙拔除术患儿喉罩拔除时间明显缩短，自主呼吸恢复率明显升高，并减少围术期不良反应的发生。
英文摘要:
      
Objective: To compare the application effects of alfentanil and fentanyl in the extraction of supernumerary teeth in the maxilla under general anesthesia with laryngeal mask in children.
Methods: Fifty-eight children who underwent extraction of supernumerary teeth under general anesthesia were selected, including 43 males and 15 females, aged 5-12 years, weighing 15-50 kg, ASA physical status Ⅰ or Ⅱ, and the expected operation time < 30 minutes. The children were divided into two groups by random number table method: afentanil group (group A) and fentanyl group (group C), 29 children in each group. Group A was given alfentanil 10 μg/kg, and then propofol 3 mg/kg for anesthesia induction; group C was given fentanyl 1.5 μg/kg, and then propofol 3 mg/kg. Both groups used 1.0 minimum alveolar effective concentration (MAC) sevoflurane in the anesthesia maintenance stage. HR and MAP were recorded before anesthesia induction (T0), before laryngeal mask placement (T1), at gingival incision (T2), and at the end of surgery (T3). The time of laryngeal mask removal, recovery time, recovery rate of spontaneous respiration, incidence of perioperative adverse reactions, satisfaction scores of the surgeon and family members of the children were recorded.
Results: Compared with group C, HR was significantly increased at T3, the time of laryngeal mask removal was significantly shortened, the recovery rate of spontaneous respiration was significantly increased, and the incidence of perioperative adverse reactions was significantly decreased in group A (P < 0.05). There were no significant differences in the recovery time, the satisfaction scores of the surgeon and the family members of the two groups.
Conclusion: Alfentanil has more advantages than fentanyl in the extraction of supernumerary teeth in the maxilla under laryngeal mask general anesthesia in children, which can not only accelerate the recovery of children, but also effectively improve the turnover rate of the operating room and reduce the occurrence of perioperative adverse reactions.
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