芬太尼与瑞芬太尼用于小儿气管异物取出术的对比研究

Comparison of Fentanyl and Remifentanil in children underwent airway foreign body removal

摘要:

目的 比较丙泊酚复合芬太尼或瑞芬太尼的全静脉麻醉用于小儿气管异物取出术的安全性和有效 性。方法 选择280 例择期行气管异物取出术的患儿，年龄1 ～ 3 岁，随机分为两组：芬太尼组（F 组，n =140）， 给予丙泊酚 2.00 ～ 3.00 mg/kg、芬太尼 2.00μg/kg 行麻醉诱导，丙泊酚 200.00 ～ 500.00μg/（ kg·min） 泵注维持麻醉；瑞芬太尼组（R 组，n =140），给予丙泊酚2.00 ～ 3.00 mg/kg、瑞芬太尼1.00 ～ 1.50μg/kg 行麻醉诱导，丙泊酚200.00 ～ 500.00μg/（kg·min）、瑞芬太尼0.10 ～ 0.20μg/（kg·min）维持麻醉。两组 患儿均保留自主呼吸。观察置镜前（T1）、置镜后1 min（T2）、3 min（T3）、退镜后3 min（T4）、10 min（T5） 的脉搏氧饱和度（SpO2）及退镜后（T6）的呼气末二氧化碳分压（PETCO2），记录置镜过程中体动、呛咳、屏 气、低氧血症的发生情况以及诱导时间、手术时间、苏醒时间和静脉药物用量。结果 两组的SpO2 在各时 点均在正常范围，但R 组SpO2 在T2 ～ 5 明显高于F 组（P <0.05）。T6 时R 组PETCO2 低于F 组（P <0.05）。R 组置镜过程中体动、呛咳的发生率与F 组相比差异无统计学意义（P >0.05），而屏气、低氧血症发生率均低 于F 组（P <0.05）。R 组诱导和苏醒时间均明显低于F 组（P <0.05），手术时间和丙泊酚用量两组比较差异无 统计学意义（P >0.05），芬太尼用量明显多于瑞芬太尼（P <0.05）。结论 丙泊酚复合芬太尼或瑞芬太尼在气 管异物取出术中安全有效，但丙泊酚复合瑞芬太尼可提供更稳定的氧合、诱导苏醒更快及减少术中不良反应 的发生。

Abstract:

Objective To compare the safety and effectiveness of Propofol-Fentanyl and Propofol-Remifentanil total intravenous anesthesia for airway foreign body (FB) removal in children. Method 280 children aged 1 ~ 3 years underwent rigid bronchoscopy for FB removal were randomized into two groups. The Fentanyl group (Group F, n = 140) were given Propofol 2.00~3.00 mg/kg and Fentanyl 2.00 μg/kg for induction and Propofol 200.00 ~ 500.00 μg/(kg·min) for maintenance of anesthesia. The Remifentanil group (Group R, n = 140) were given Propofol 2.00 ~ 3.00 mg/kg and Remifentanil 1.00 ~ 1.50 μg/kg for induction of anesthesia, while anesthesia was maintained with Propofol 200.00 ~ 500.00 μg/(kg·min) and Remifentanil 0.10 ~ 0.20 μg/(kg·min). All the children during the procedure were with spontaneous respiration. SpO2 before inserting rigid bronchoscope (T1), 1 min (T2) and 3 min (T3) after insertion, 3 min (T4) and 10 min (T5) after extraction were recorded. PETCO2 after endoscopy (T6) was measured. Adverse events, including body movement, cough, breath-holding, and hypoxemia,were observed. The time of induction, surgery, recovery and the total dosage of the intravenous agents were recorded. Results SpO2 of the two groups were in normal range at T1 ～ 5, which was higher in group R than group F at T2 ～ 5 (P < 0.05). PETCO2 of group R was lower than group F at T6 (P < 0.05). The rate of body movement and cough were comparable between the two groups (P > 0.05), while breath-holding and hypoxemia were more frequent in group F (P < 0.05). The time of induction and recovery were shorter in group R (P < 0.05), while surgery time and the Propofol dosage were similar (P > 0.05). The total dose of Fentanyl was significantly higher than Remifentanil (P < 0.05). Conclusion Combination of Propofol with Fentanyl or Remifentanil both produce effective anesthesia in children undergoing FB removal. But Propofol-Remifentanil provides more stable oxygen saturation, faster induction and recurrence of anesthesia, as well as less intraoperative complications.