【摘要】 目的:应用舒芬太尼或芬太尼复合全麻诱导,观察两者对扁桃体摘除术患儿血流动力学和麻醉苏醒质量的影响。方法:40例ASAI级择期行扁桃体摘除术患儿,随机分为舒芬太尼组(S组,n=20)和芬太尼组(F组,n=20)。两组诱导时均静注咪唑安定0.1mg/kg,异丙酚2mg/kg,维库溴铵0.1mg/kg,S组静注舒芬太尼0.3μg/kg,F组静注芬太尼3μg/kg,5min后行气管插管。术中麻醉维持用异丙酚每小时2～4mg/kg持续微泵输注,七氟醚1.5%～2%吸入,机械控制呼吸。术毕新斯的明拮抗肌松药残余作用。记录麻醉前、麻醉诱导后2min、气管插管时、放置开口器、剥离扁桃体时的血流动力学及BIS变化;患儿自主呼吸恢复时间、拔管时间、睁眼时间及出PACU时间;拔管即刻、拔管后5min、10min、出PACU时的躁动评分和Ramsay评分,以及麻醉恢复期间发生的不良反应。结果:S组围术期血流动力学稳定,与F组比较差异有统计学意义(P<0.05)。麻醉苏醒期S组镇静评分高于F组,躁动评分低于F组,差异有统计学意义(P<0.05)。结论:舒芬太尼0.3μg/kg复合诱导比芬太尼3μg/kg更能有效地抑制小儿气管插管时心血管应激反应,术中血流动力学稳定,术后苏醒快而平稳。更多还原

【Abstract】 Objective:To compare the effects of sufentanil with fentnyl on hemodynamic during general anesthesia in children undergoing tonsillectomy. Methods:forty ASA grade Ⅰ children, scheduled for tonsillectomy under general anesthesia were randomly divided into fentanyl group （F, n=20） and sufentanil grorp （S, n=20）. They were ramdomly given fentanyl 3μg/kg or sufentnil 0.3μg/kg in anesthesia induction. Patients were induced with midazolam, profofol and vecuronium for tracheal intubation and maintained with propofol, sevoflurane and vecuronium. SBP, DBP, MAP, HR and SpO₂ were recorded before induction of anestbesia, immediately after tracheal intubation,3minutes after intubation. The recovery of spontaneous breathing time, waking time, extubation time and complication related to recocery and extubation were recorded. VRS and Rammsay score were measured during postoperation. Result:There were no differences on hemodynamic parameters between the two groups during anesthesia induction（P<0.05）, but there were significant differences when placing mouth-gag and stripping tonsill（P<0.05）. There were significant differences on spontaneous breathing time, extubation time, waking time between the two groups during postoperative（P<0.05）. Group S had higher sedation score lower agitation score compared to group F postoperatively（P<0.05）. Conclusinn:Sufentanil not only had better homodynamic stability during anesthesia induction and operative procedure but also had better postoperative recovery quality than fentanyl for children undergoing tonsillectomy.更多还原