异丙酚复合不同镇痛药物用于小儿输尿管镜 检查术的比较观察

Comparative observation of propofol combined with different analgesic drugs used in children under ureteroscope

摘要:

目的 比较异丙酚分别复合氯胺酮、舒芬太尼及瑞芬太尼用于小儿输尿管检查术的麻醉效果。方法 选择60例ASAⅠ～Ⅱ级小儿输尿管检查手术，随机分为氯胺酮-异丙酚静脉复合麻醉组（KP组），舒芬太尼-异丙酚静脉复合麻醉组（SP组）和瑞芬太尼-异丙酚静脉复合麻醉组（RP组）每组20例。采用全凭静脉麻醉，静脉注射首量后分别静脉泵注异丙酚及镇痛药物。观察并记录围术期心率、血压、呼吸和脉搏氧饱和度的变化以及异丙酚使用量、苏醒时间、术后镇静Ramsay评分、躁动评分和术后恶心呕吐的发生率等不良反应。结果 3组患儿术中的心率、血压、呼吸和脉搏氧饱和度均有不同程度的下降，与KP组相比，SP组和RP组的心率、血压、呼吸下降明显（P <0.05）。术后苏醒时间KP组明显延长（P <0.05），RP组术后镇静Ramsay评分低于其他两组（P <0.05）和躁动评分高于其他两组（P <0.05）。结论 异丙酚分别复合氯胺酮、舒芬太尼及瑞芬太尼均能安全用于小儿输尿管镜检查术，但异丙酚复合舒芬太尼苏醒期平稳舒适，更适合于小儿日间手术麻醉的推广应用。

Abstract:

【Objective】 To compare the effect of propofol compound ketamine, sufentanil and remifentanil respectively used in children examined with ureteroscopy. 【Methods】 Sixty ASA Ⅰ～Ⅱchildren were randomly divided into 3 groups, ketamine-propofol group(group, KP), sufentanil-propofol group (group SP), remifentanil-propofol group (group, RP), 20 cases in each group. All received intravenous anesthesia, infusing propofol and analgesic drugs. Perioperative heart rate, blood pressure, breathing rate and pulse oxygen saturation change and propofol usage, revival time, postoperative sedation Ramsay grade, agitation score and the incidence of postoperative nausea and vomiting and other adverse reactions were all observed and recorded. 【Results】 The heart rate, blood pressure, breathing rate and pulse oxygen saturation in three groups were all declined in vary degrees. Compared with the KP group, the heart rate, blood pressure and breathing rate of SP and RP groups were down obviously(P <0.05). Postoperative revival time of KP group was significantly prolonged (P <0.05), postoperative sedation Ramsay score of RP group was lower than the other two groups (P <0.05) and agitation score was higher than the other two groups(P <0.05). 【Conclusion】 Propofol compound ketamine, sufentanil and remifentanil respectively used in children with ureteroscopy is safe, but propofol compound sufentanil is stable and comfortable, more suitable for extension and application for the day surgery in children.