舒芬太尼在儿童全麻肠镜检查中的临床应用

Sufentanil in children’s enteroscopy under general anesthesia

摘要:

目的??观察舒芬太尼在儿童全麻肠镜检查中的临床效果和安全性。方法?择期全麻下行肠镜检查患儿80例，年龄5～10岁，体重18～35 kg，随机分为舒芬太尼组（S组）和芬太尼组（F组），每组40例。S组静注舒芬太尼0.2μg/kg，F组静注芬太尼2.0μg/kg，随后两组均静注丙泊酚2.50 mg/kg，置入双腔喉罩，丙泊酚6.00～8.00 mg/（kg?h）泵注复合七氟醚2%～3%维持麻醉。记录麻醉诱导前（T0）、放置喉罩时（T1）、肠镜至回盲瓣时（T2）及手术结束时（T3）等时点的心率（HR）、平均动脉压（MAP）、脉搏氧饱和度（SpO2）及呼吸频率（RR），同时记录苏醒时间、注射部位疼痛、术中体动、术中有无返流、术后舌后坠、恶心呕吐、咽喉部疼痛及躁动等情况。结果?F组在T1和T2时HR、MAP高于麻醉诱导前（P <0.05），而S组HR、MAP差异无统计学意义（P >0.05）。T1时两组RR均较诱导前明显降低（P <0.05），组间比较差异无统计学意义（P >0.05）。T1、T2时S组HR和MAP明显低于F组（P <0.05）。S组注射疼、诱导及苏醒时间、术后躁动发生率均较F组低（P <0.05）。结论?舒芬太尼用于静吸复合全麻双腔喉罩通气下行小儿肠镜检查安全有效，麻醉效果满意，术中呼吸循环更稳定，术后苏醒质量高。

Abstract:

Objective?To observe the clinical effect and safety of using Sufentanil in children’s enteroscopy under general anesthesia.?Methods?80 ASAⅠ~Ⅱchildren, aged 5~10 years, weighed 18~35 kg, who scheduled for enteroscopy, were randomly divided into two groups: group Sufentanil (group S, n = 40) and group Fentanyl (group F, n = 40). Group S were given Sufentanil 0.2 μg/kg and Propofol 2.50 mg/kg in intravenous injection, group F were given Fentanyl 2.0 μg/kg and Propofol 2.50 mg/kg in intravenous injection. Proseal laryngeal mask airway (PLMA) was inserted when eyelash reflex disappeared and the submaxilla was loosen, and Propofol 6.00 ~ 8.00 mg/(kg?h) and 2% ~ 3% Sevoflurane inhalation for anesthesia maintenance. Parameters of HR, MAP, SpO2 and RR were recorded at different times: before induction (T0), insertion of PLMA (T1), enteroscopy to the ileocecal valve (T2) and end of operation (T3). Also, time of induction and recovery, pain on injection, perioperative body movement, intraoperative regurgitation, glossocoma, nausea and vomiting, throat pain and agitation were also recorded.?Results?Compared with T0, HR and MAP at T1 and T2 were significantly higher in group F (P < 0.05), but in group S, there was no significant differences (P > 0.05). RR in both groups were significantly lower at T1 compared with T0 (P < 0.05), and no significant differences between the two groups (P > 0.05). HR, MAP and RR were significantly lower in group S than that in group F at T1 and T2 times (P < 0.05). Pain on injection, body movement and agitation were significantly lower in group S than that in group F (P < 0.05). Induction and recovery time in group S were significantly shorter than that in group F (P < 0.05).?Conclusions?The anesthetic effect of Sufentanil for combined intravenous and inhalation anesthesia in children’s enteroscopy is safe and satisfactory. It could provide more smoothly intraoperative hemodynamics and higher quality of awakening.