【摘要】 目的观察七氟醚吸入复合丙泊酚-瑞芬太尼静脉麻醉在自主呼吸下小儿硬质气管镜气管异物取出术的麻醉效果和不良事件发生率。方法 选取2019年3月至2021年3月期间于福建省立医院行小儿气管异物取出术的1～5岁82例患儿资料进行研究,按照术中麻醉方式的不同将其分为对照组（给予丙泊酚-瑞芬太尼复合静脉麻醉,n=41）与研究组（给予七氟烷吸入复合丙泊酚-瑞芬太尼静脉麻醉,n=41）;对比两组麻醉前、置镜前、退镜后、术毕时间点的无创血压（blood pressure,BP）、心率（heart rate,HR）、呼吸频率（respiratory rate,RR）、经皮动脉血氧饱和度（percutaneous arterial oxygen saturation,用SpO₂表示）的变化,记录两组手术时间、支气管镜出入次数、术后苏醒时间,并观察两组患儿术中及术后不良事件发生情况。结果 研究组麻醉前、术毕的BP、HR、RR、SpO₂与对照组比较,未见明显差异（P>0.05）;研究组置镜前、退镜后:BP低于对照组(t_置镜前=6.130,P_置镜前<0.05;t_退镜后=8.903,P_退镜后<0.05),HR低于对照组(t_置镜前=2.766,P_置镜前<0.05;t_退镜后=8.297,P_退镜后<0.05),RR高于对照组(t_置镜前=5.374,P_置镜前<0.05;t_退镜后=5.378,P_退镜后<0.05),SpO₂高于对照组(t_置镜前=5.023,P_置镜前<0.05;t_退镜后=5.378,P_退镜后<0.05);研究组手术时间、术后苏醒时间均显著短于对照组(t_手术时间=8.827,P_手术时间<0.05;t_{术后苏醒时间}=15.127,P_{术后苏醒时间}<0.05),其出入镜次数显著少于对照组（t=13.443,P<0.05）;研究组术中不良反应发生率为9.76%,低于对照组的29.27%（χ²=4.970,P=0.026）。结论七氟烷吸入复合丙泊酚-瑞芬太尼静脉麻醉在硬质气管镜下小儿气管异物取出术中有较好的麻醉效果,减少术中及术后不良事件的发生,缩短患儿的手术时间及苏醒时间。更多还原

【Abstract】 Objective To observe the effectiveness of anesthesia and the incidence of adverse events in extraction of a foreign body in pediatric airway by rigid bronchoscopy under spontaneous respiration using combination of inhaled sevoflurane and intravenous propofol-refentanyl through total intravenous anesthesia （TIVA）.Methods Eighty-two children aged 1 to 5 years undergoing rigid bronchoscopy in Fujian Provincial Hospital between March 2019 and March 2021 were selected for the study.They were divided into control group （combination of propofol remifentanil for TIVA,n=41） and the experimental group （combination of inhaled sevoflurane and intravenous propofol-refentanyl,n=41） according to the different methods of intraoperative anesthesia.The non-invasive blood pressure （BP）,heart rate （HR）,respiratory rate （RR）,and percutaneous arterial oxygen saturation （expressed as SpO₂） were compared between the two groups before anesthesia and bronchoscope insertion as well as after bronchoscope removal and anesthesia.The operation duration,the number of access,and postoperative awakening time were recorded,and the adverse reactions of each group before and after the operation were observed.Results There was no significant difference in the BP,HR,RR and SpO₂ between the two groups before anesthesia and after the operation （P> 0.05）.BP before bronchoscope insertion and after removal of the experimental group were lower than those of the control group (t_{before bronchoscope insertion}=6.130,t_{after bronchoscope}=8.903,P<0.05);HR before bronchoscope insertion and after removal of the experimental group were lower than those of the control group (t_{before bronchoscope insertion}=2.766,t_{after bronchoscope}=8.297,P<0.05);RR before bronchoscope insertion and after removal of the experimental group were higher than those of the control group(t_{before bronchoscope insertion}=5.374,t_{after bronchoscope}=5.378,P<0.05);SpO₂ before bronchoscope insertion and after removal of experimental group were higher than those of the control group (t_{before bronchoscope insertion}=5.023,t_{after bronchoscope}=5.378,P<0.05);the operation duration and postoperative awakening time in the experimental group were significantly shorter than those of the control group (t_{surgical time}=8.827,t_{postoperative awakening time}=15.127,P<0.05);the number of access was significantly less than that of the control group （t=13.443,P<0.05）,and the intraoperative incidence of adverse reactions in the experimental group was lower than that in the control group （9.76% vs 29.27%,χ²=4.970,P=0.026）.Conclusion Combination of inhaled sevoflurane and intravenous propofol-refentanyl through TIVA is highly effective in extraction of a foreign body in pediatric airway by rigid bronchoscopy.It reduces the incidence of intraoperative and postoperative adverse events and shortens the operation time and awakening time of children.更多还原