丙泊酚分别复合芬太尼、舒芬太尼在喉罩通气下小儿日间腹股沟斜疝手术麻醉中的效果对比

林玉志

【摘要】 目的：对比丙泊酚分别复合芬太尼、舒芬太尼在喉罩通气下小儿日间腹股沟斜疝手术麻醉中的效果。方法：选取2016年10月-2018年10月于本院手术的腹股沟斜疝患儿82例，参照奇偶数法将患儿随机分成F组（以芬太尼进行麻醉）和S组（以舒芬太尼进行麻醉），各41例。对比两组麻醉效果、对生命体征的影响及不良事件。结果：S组的苏醒时间、麻醉诱导时间均短于F组，躁动评分低于F组，Ramsay镇静评分高于F组（P<0.05）;F组T1、T2时平均动脉压（MAP）和心率（HR）均高于T0时，且均高于S组同一时间点的水平（P<0.05），而S组麻醉不同时间点的MAP和HR比较，差异均无统计学意义（P>0.05）;S组术中体动、注射部位疼痛和术后躁动发生率均低于F组（P<0.05）。结论：舒芬太尼在小儿腹股沟斜疝手术中能达到更好的麻醉效果，药效发挥和患儿苏醒均较快，且能减轻患儿躁动和生命体征的波动，用药安全性较高。

【关键词】 日间手术; 舒芬太尼; 麻醉效果; 生命体征; 安全性

【Abstract】 Objective：To compare the effects of Propofol combined with Fentanyl and Sufentanil in anesthesia of children with inguinal hernia during laryngeal mask ventilation.Method：82 children with inguinal hernia operated from October 2016 to October 2018 in our hospital were selected，they were randomly divided into group F（anesthesia with Fentanyl）and group S（anesthesia with Sufentanil），with 41 cases in each group.The the effects of anesthesia，the impact on vital signs and adverse events in two groups were compared.Result：The awaking time and anesthesia induction time of group S were shorter than those of group F，the score of agitation was lower than that of group F，and the score of Ramsay sedation score was higher than that of group F（P<0.05）.Average arterial pressure（MAP）and heart rate（HR）in group F at T1 and T2 were higher than those at T0，and both were higher than those at the same time point in group S（P<0.05）.Comparison of MAP and HR at different time points of anesthesia in group S showed no statistically significant difference（P>0.05）.The incidence of intraoperative motion，injection site pain and postoperative agitation in group S were lower than those in group F（P<0.05）.Conclusion：Sufentanil can achieve better anesthesia effect in operation of inguinal hernia，the efficacy of drug and wakefulness are faster，and it can alleviate the agitation and fluctuation of vital signs and the medication safety is higher.

【Key words】 Day surgery; Sufentanil; Anesthesia effect; Vital signs; SafetyFirst-authors address：Wuchuan Peoples Hospital，Wuchuan 524500，China

doi：10.3969/j.issn.1674-4985.2019.17.017

日间手术是治疗小儿腹股沟斜疝的普遍方法，手术时间较短、周转较快，因此其对麻醉药物在迅速起效、加快苏醒等方面的要求较高，尤其是由于小儿机体稳定性较差，因此更要注意麻醉过程中患儿生命体征的稳定和安全性[1]。芬太尼与舒芬太尼均是阿片受体的强效激动剂，是临床应用较普遍的高效麻醉药物，常与丙泊酚联合使用，能达到较好的麻醉效果[2]，其中舒芬太尼是芬太尼的一种衍生物，其在成人手术麻醉中具有起效和清除较快、对血流动力学和生命体征影响较小等优势，尤其是对成人呼吸和循环系统的抑制几乎可以忽略不计[3-4]，但两种药物在喉罩通气下日间手术，尤其是对小儿生命体征的影响和安全性方面的研究尚少。為此，本研究对比芬太尼、舒芬太尼分别复合丙泊酚在喉罩通气下小儿日间腹股沟斜疝手术麻醉中的效果，现报道如下。……