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| 阿芬太尼复合丙泊酚对扁桃体腺样体切除术患儿血流动力学的影响 |
| Effect of alfentanil combined with propofol on hemodynamics in children undergoing tonsillectomy and adenoidectomy |
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| DOI：10.12089/jca.2026.04.007 |
| 中文关键词: 扁桃体腺样体切除术 小儿 阿芬太尼 芬太尼 丙泊酚 全身麻醉 血流动力学 |
| 英文关键词: Tonsillectomy and adenoidectomy Child Alfentanil Fentanyl Propofol General anesthesia Haemodynamics |
| 基金项目:北京医学奖励基金会（YXJL-2023-0552-0144） |
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| 中文摘要: |
目的： 探讨两种剂量阿芬太尼复合丙泊酚对扁桃体腺样体切除术患儿血流动力学的影响。
方法： 选择经气管插管全身麻醉下行扁桃体腺样体切除术的患儿，年龄5～10岁，BMI 13.0~19.5 kg/m2，ASA Ⅰ级。将患儿随机分为三组：芬太尼4 μg/kg组（C组）、阿芬太尼20 μg/kg组（A1组）和阿芬太尼30 μg/kg组（A2组）。麻醉诱导时，C组给予芬太尼4 μg/kg，A1组给予阿芬太尼20 μg/kg，A2组给予阿芬太尼30 μg/kg，且三组均给予丙泊酚2~4 mg/kg。主要指标为气管插管后1 min与麻醉诱导前MAP的差值（ΔMAP）。次要指标包括麻醉诱导前、气管插管后1、5 min、手术开始后1 min时HR、ΔHR（各时点HR与麻醉诱导前HR差值）、MAP，麻醉诱导前、气管插管后5 min、手术开始后1 min时MAP与麻醉诱导前MAP差值（ΔMAP），PACU停留时间，拔管后5 min、出PACU前FLACC疼痛评分和拔管后5 min时苏醒期谵妄量表（PAED）评分。不良反应包括低血压、心动过缓、呼吸抑制、嗜睡、低氧血症等。
结果： 共纳入患儿180例，每组60例。与C组比较，A1组在气管插管后1、5 min、手术开始后1 min时HR、ΔHR明显增快，MAP、ΔMAP明显升高（P＜0.05）。与A1组比较，A2组在气管插管后1 min、手术开始后1 min的HR、ΔHR明显减慢，MAP、ΔMAP明显降低（P＜0.05）。与C组比较，A1组拔管后5 min和出PACU前FLACC评分明显升高(P＜0.05)，A2组PACU停留时间明显缩短，拔管后5 min PAED评分明显降低（P＜0.05）。与C组比较，A2组低血压和嗜睡发生率明显降低（P＜0.05）。
结论： 与阿芬太尼20 μg/kg比较，在扁桃体腺样体切除术患儿麻醉诱导中使用阿芬太尼30 μg/kg复合丙泊酚2~4 mg/kg可以有效维持血流动力学稳定。 |
| 英文摘要: |
Objective: To investigate the hemodynamic effects of two doses of alfentanil combined with propofol in children undergoing tonsillectomy and adenoidectomy.
Methods: Children aged 5-10 years, BMI 13.0-19.5 kg/m2, ASA physical status Ⅰ, scheduled for tonsillectomy and adenoidectomy under general anesthesia via tracheal intubation were enrolled. The children were randomly allocated into three groups: group C (fentanyl 4 μg/kg), group A1 (alfentanil 20 μg/kg), and group A2 (alfentanil 30 μg/kg). During anesthesia induction, group C received fentanyl 4 μg/kg, group A1 received alfentanil 20 μg/kg, and group A2 received alfentanil 30 μg/kg. All three groups received propofol 2-4 mg/kg. The primary outcome was the difference in mean arterial pressure (ΔMAP) between 1 minute after tracheal intubation and before induction of anesthesia. The secondary outcomes included HR, ΔHR (the difference in HR at each time point versus before induction), and MAP before induction, 1 and 5 minutes after tracheal intubation, and 1 minute after the start of surgery; the differences (ΔMAP) in MAP 5 minutes after tracheal intubation and 1 minute after the start of surgery relative to MAP before anesthesia induction; length of stay in the PACU; FLACC pain scores 5 minutes after extubation and before PACU discharge; and the pediatric anesthesia emergence delirium (PAED) scale 5 minutes after extubation. Adverse events included hypotension, bradycardia, respiratory depression, drowsiness, hypoxemia, and others.
Results: A total of 180 children were included, 60 patients in each group. Compared with group C, group A1 exhibited significantly higher HR, ΔHR, MAP, and ΔMAP 1 and 5 minutes after tracheal intubation and 1 minute after the start of surgery (P < 0.05). Compared with group A1, group A2 had significantly lower HR, ΔHR, MAP, and ΔMAP 1 minute after tracheal intubation and 1 minute after the start of surgery (P < 0.05). Compared with group C, group A1 had significantly higher FLACC scores 5 minutes after extubation and before PACU discharge, whereas group A2 had a significantly shorter PACU stay and a significantly lower PAED score 5 minutes after extubation (P < 0.05). Compared with group C, group A2 had a significantly lower incidence of hypotension and drowsiness (P < 0.05).
Conclusion: Compared with alfentanil 20 μg/kg, administration of alfentanil 30 μg/kg combined with propofol 2-4 mg/kg during anesthesia induction can effectively maintain hemodynamic stability in children undergoing tonsillectomy and adenoidectomy. |
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