瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性观察

doi:10.3969/j.issn.1007-3205.2022.02.017

摘要/Abstract

摘要： 目的探讨瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性。
方法选取本院行先天性心脏病介入术治疗的患儿120例，随机分为丙泊酚复合瑞芬太尼（propofol and remifentanil,PR）组与丙泊酚复合七氟醚（propofol and sevoflurane,PS）组，均60例。PR组麻醉诱导：瑞芬太尼4.0 μg/L、丙泊酚4.0 mg/L。麻醉维持：丙泊酚2.5～4.0 mg/L、瑞芬太尼4.0 μg/L，调节丙泊酚浓度使听觉诱发电位指数维持在25~30。PS组麻醉诱导：丙泊酚2 mg/kg及经喉罩七氟醚吸入，浓度由2%开始增大（最大浓度7%）。麻醉维持：丙泊酚6 mg·kg-1·h-1，七氟醚1%～3%。比较2组诱导前（T0）、置喉罩时（T1）、置入喉罩后3 min（T2）、手术结束（T3）及拔除喉罩（T4）的心率、呼吸频率、平均动脉压、血氧饱和度、颈静脉球血氧饱和度（jugular bulb venousoxygen saturation,S-jvO2）及脑动静脉血氧含量差（cerebral arterial venous oxygen content difference,Da-jvO2）、拔管时间、苏醒时间、麻醉恢复室停留时间、术后住院时间、并发症发生率。
结果 ①随着时间的变化，2组心率、呼吸频率、平均动脉压均呈先降低、后升高的变化趋势，组间比较、时点间比较以及组间和时间点的交互作用的差异均有统计学意义（P＜0.05）。②随着时间的变化，2组S-jvO2、Da-jvO2均呈先降低后升高的变化趋势，组间比较、时间点比较以及分组和时间点的交互作用差异均有统计学意义（P＜0.05）。③2组麻醉恢复室停留时间、术后住院时间的差异无统计学意义（P＞0.05），PS组拔管时间短于PR组（P＜0.05）。④2组并发症总发生率分别为13.33%和10.00%，差异无统计学意义（P＞0.05）。
结论丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的术中生命体征较瑞芬太尼联合丙泊酚靶控输注更为平稳，且更有利于脑氧供需平衡。

关键词: 心脏病, 丙泊酚, 七氟醚

Abstract: Objective To explore the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia for interventional treatment of congenital heart disease(CHD) in children.
Methods A total of 120 children who underwent interventional treatment for CHD in our hospital were selected and randomly divided into the propofol and remifentanil(PR) group(n=60) and the propofol and sevoflurane(PS) group(n=60). Anesthesia induction was performed in the PR group with remifentanil(4.0 μg/L) and propofol(4.0 mg/L). Anesthesia was maintained with propofol(2.5～4.0 mg/L) and remifentanil(4.0 μg/L). The concentration of propofol was adjusted to maintain A-line ARX index at 25～30. Anesthesia induction was performed in the PS group using propofol(2 mg/kg) and sevoflurane inhalation throμgh a laryngeal mask, and the concentration was increased from 2%(maximum concentration 7%). Anesthesia maintenance was kept using propofol(6 mg·kg-1·h-1) and sevoflurane(1% to 3%). The heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP), blood oxygen saturation(SpO2), jugular bulb venousoxygen saturation(S-jvO2) and cerebral arterial venous oxygen content difference(Da-jvO2) before induction(T0), at laryngeal mask insertion(T1), at 3 min after laryngeal mask insertion(T2), immediately after operation(T3), and at laryngeal mask removal(T4), as well as extubation time, recovery time, residence time in anesthesia recovery room, postoperative hospital stay, complication and rate were compared between the two groups.
Results ①With the change of time, HR, RR, and MAP of the two groups initially decreased and then increased. The differences between groups, time points and interactions between groups and time points were statistically significant(P＜0.05). ②With the change of time, S-jvO2 and Da-jvO2 in the two groups initially decreased and then increased. The differences between the groups, the time points, and the interaction between groups and time points were all statistically significant(P＜0.05). ③There were no significant difference in residence time in anesthesia recovery room and hospital stay between two groups(P＞0.05). The extubation time of the PS group was shorter than that of the PR group(P＜0.05). ④The total incidence of complications in the two groups was 13.33% and 10.00% respectively, and the difference was not statistically significant(P＞0.05).
Conclusion The intraoperative vital signs using propofol combined with sevoflurane inhalation general anesthesia for CHD in children undergoing interventional surgery are more stable than those using remifentanil combined with propofol target-controlled infusion, and it is more conducive to the balance of cerebral oxygen supply and demand.

Key words: heart disease, propofol, sevoflurane

刘新燕, 董丽蕴, 陈永学, 王新波, 孙颜, 吕航宇. 瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性观察[J]. 河北医科大学学报, 2022, 43(2): 208-212,228.

LIU Xin-yan, DONG Li-yun, CHEN Yong-xue, WANG Xin-bo, SUN Yan, LYU Hang-yu. Observation on the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia in interventional procedures for children with congenital heart disease[J]. Journal of Hebei Medical University, 2022, 43(2): 208-212,228.

[1]	梁冰, 徐辉. 超声引导下婴幼儿心脏手术颈内静脉置管深度的测量定位研究[J]. 河北医科大学学报, 2023, 44(3): 342-346.
[2]	张立立, 白小丽, 陈蕾, 李芳, 杨冬雪, 尚瑞媛. 瑞芬太尼联合丙泊酚靶控输注维持麻醉在扁桃体切除术患儿中的应用效果[J]. 河北医科大学学报, 2022, 43(4): 476-480.
[3]	王雪萍, 张红玉, 陈海明. 七氟烷麻醉对老年肺癌患者术后血清IL-1、ICAM-1表达及肺部并发症的影响[J]. 河北医科大学学报, 2021, 42(9): 1084-1088.
[4]	刘叶, 李红, 刘枝, 毛慧敏. 不同麻醉方式对老年女性腹腔镜手术患者术后认知功能的影响[J]. 河北医科大学学报, 2021, 42(7): 846-850.
[5]	武婕, 陈燕, 杜晓宣. 舒芬太尼丙泊酚静脉复合麻醉对骨髓间充质干细胞移植治疗创伤性脑损伤大鼠的影响[J]. 河北医科大学学报, 2021, 42(4): 454-460,465.
[6]	井淑艳, 张家恺, 刘春颖, 侯瑞鸿, 杨文昆, 任庆云. 心脏CTA诊断复杂性先天性心脏病患者冠状动脉异常的价值[J]. 河北医科大学学报, 2020, 41(8): 952-956.
[7]	王园园（综述），柳磊（审校）. 小儿先天性心脏病术后容量评估方法#br#[J]. 河北医科大学学报, 2020, 41(3): 350-353.
[8]	吕瑛, 李小兵, 黄建成, 李志杰, 张会军, 王军. 低体重婴幼儿危重先心病合并肺部感染的外科治疗[J]. 河北医科大学学报, 2020, 41(12): 1406-1411.
[9]	程艳欣，常和平，张〓健，刘亚静，赵森明*. 盐酸纳布啡复合丙泊酚用于门诊人工流产术麻醉的疗效及安全性[J]. 河北医科大学学报, 2018, 38(11): 1324-1329.
[10]	张〓宁1，程〓燕2，郝继英1，李治国3. 右美托咪定或丙泊酚复合芬太尼用于无痛纤维支气管镜检查效果比较[J]. 河北医科大学学报, 2017, 37(4): 428-432.
[11]	姜〓博1，宋铁鹰1*，赵晓波2，田〓军3，吕忠立4，时建林5. 右美托咪定联合七氟醚麻醉对EDAS缺血性烟雾病患儿脑氧代谢的影响[J]. 河北医科大学学报, 2016, 37(9): 1096-1099.
[12]	蔺发林1，姜〓博2*，马〓琨 3，赵建辉2，彭景燕2，李玉霞2 . 依托咪酯与丙泊酚对烟雾病患儿脑-硬膜-动脉血管融通术中脑氧代谢的影响[J]. 河北医科大学学报, 2016, 37(12): 1510-1513.
[13]	姜博 1,宋铁鹰 1,赵晓波 2,田军 3,吕忠立 4,时建林 5. 右美托咪定联合七氟醚麻醉对神经外科择期手术患儿脑氧代谢的影响[J]. 河北医科大学学报, 2016, 37(10): 1222-1226.
[14]	张丽,张利宣,张素华,王静,丁芳. LMNA 基因 C.1583C>G 突变致 Emery-Dreifuss 型#br# 肌营养不良 2 个家系心脏受累特点研究[J]. 河北医科大学学报, 2016, 37(1): 5-8,12.
[15]	于健;单士强;王琦;朱春华. 七氟醚预处理对先天性心脏病患儿心内直视手术的心肌保护作用[J]. , 2014, 35(9): 1032-1032.

瑞芬太尼联合丙泊酚靶控输注及丙泊酚复合吸入七氟醚静吸全麻用于小儿先天性心脏病介入术的安全性与有效性观察

Observation on the safety and effectiveness of remifentanil combined with propofol target-controlled infusion and propofol combined with sevoflurane inhalation general anesthesia in interventional procedures for children with congenital heart disease

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