钟霓 黎哲琪 杨正华

[摘要] 目的 探讨瑞芬太尼复合异丙酚用于小儿短小手术的麻醉效果。 方法 选取我院2013年12月～2015年3月收治的76例需进行短小手术的男性患儿为研究对象。将76例患儿按照麻醉方式分为观察组30例与对照组36例，观察组采用瑞芬太尼复合异丙酚麻醉，对照组采用氯胺酮麻醉。比较两组患儿的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、不良反应发生率及苏醒时间。 结果 两组患儿术前的HR、MAP、SpO2比较差异无统计学意义（P>0.05），与术前比较，两组术中的SpO2变化不明显（P>0.05），但对照组术中的HR显著增快，MAP显著增高（P<0.05）。观察组术后苏醒时间较对照组显著缩短，且不良反应发生率明显低于对照组（P<0.05）。 结论 在小儿短小手术中应用瑞芬太尼复合异丙酚全身麻醉，能够在满足手术需要的同时，显著缩短苏醒时间，降低不良反应发生率，是一种较好的复合麻醉方式。

[关键词] 瑞芬太尼；异丙酚；小儿短小手术；麻醉

[中图分类号] R726.1 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0129-03

[Abstract] Objective To explore the anesthesia effect of remifentanil combined with propofol applied in minor surgery for children. Methods 76 male children receiving minor surgery treated by our hospital from December 2013 to March 2015 were selected as study group and they were divided into observation group （30 cases） and control group （36 cases） according to anesthesia method.Observation group was given remifentanil combined with propofol for anaesthesia，while control group was given ketamine for anaesthesia.The heart rate （HR），mean arterial pressure （MAP） and blood oxygen saturation （SpO2），awake time and incidence rate of adverse reaction between two groups was compared respectively. Results Before surgery，HR，MAP and SpO2 between two groups was not significantly different （P>0.05）；compared with before operatin，the change of SpO2 of two groups during operation was not obvious （P>0.05），but HR，MAP of control group was significantly increased during operation （P<0.05）.After surgery，awake time of observation group was significantly shorter than that of control group，and the incidence rate of adverse reaction in observation group was significantly lower than that of control group （P<0.05）. Conclusion Remifentanil combined with propofol used for general anesthesia in minor surgery for children can meet the requirement of operation，and it can obviously shorten awake time，reduce the incidence rate of adverse reaction.It is a better compound anesthesia method.

[Key words] Remifentanil；Propofol；Minor surgery for children；Anesthesia

儿童身体正处于发育阶段，在对儿童行麻醉时需谨慎对待。小儿麻醉要求较严格，需要同时注意药物的种类与用药量。氯胺酮是临床上小儿手术中最常用也是最安全的麻醉药物，一般采用静脉注射方式用药，随着手术时间的延长及反复应用氯胺酮使机体对其产生耐受，氯胺酮的用量不断增加，大剂量氯胺酮容易引起患儿苏醒时间延长，甚至出现幻觉、恶心、呕吐、错视等不良反应[1]。随着麻醉学的不断发展，更多新型麻醉药物的出现为提高临床小儿手术麻醉安全性带来了可能。瑞芬太尼与异丙酚均为新型麻醉类药物，其中前者为阿片受体激动剂，后者为非巴比妥类静脉麻醉药，两者均具有起效快、作用时间短等优点[2-3]，但将两种药物联合应用于小儿麻醉的研究并不多见。由于全身……