不同剂量舒芬太尼在小儿腹腔镜下疝内环口缝扎术中的应用选择和效果分析

Application selection and effect analysis of different dosages of sufentanil in children's laparoscopic herniorrhaphy of internal ring orifice

摘要:

目的 探究不同剂量舒芬太尼用于小儿腹腔镜下疝内环口缝扎术的临床效果。方法 选取2015年1月—2018年1月南京医科大学附属儿童医院收治的腹股沟斜疝患儿120例，均于腹腔镜下行疝内环口缝扎术。术前按照随机数字表法将其分为A、B和C组，每组40例。3组患儿均采用静脉诱导，A、B、C组患儿依次给予舒芬太尼（0.3、0.4、0.5?μg/kg）、咪哒唑仑（0.1?mg/kg）和丙泊酚（2.0?mg/kg）。术中采用顺苯磺阿曲库铵0.12?mg/（kg·h）和丙泊酚10 mg/（kg·h）维持，根据心率（HR）决定是否追加舒芬太尼。记录各组患儿麻醉诱导前（T0）、气管插管前（T1）、气管插管时（T2）、手术开始时（T3）、气腹建立时（T4）、气腹后5 min（T5）和气管拔管时（T6）的HR、收缩压（SBP）和血氧饱和度（SpO2）。比较3组麻醉诱导时间、手术时间、苏醒时间、舒芬太尼追加率、不良反应情况及术后Wong-Baker脸谱法镇痛评分和Ramsay镇静评分。结果 A组麻醉诱导时间长于B和C两组（P?<0.05）。3组术中不同时间点的HR、SBP和SpO2有差异（P?<0.05）。3组术后不同时间点镇痛和镇静评分差异有统计学意义（P?<0.05），A组镇痛评分高于B和C组，但镇静评分低于B和C组。结论 对行腹腔镜下疝内环口缝扎术的患儿，诱导麻醉选用0.4 μg/kg舒芬太尼可提供满意的麻醉效果，安全性高，值得推广。

Abstract:

Objective To explore the dose and effect of sufentanil in laparoscopic hernia suture ligation in children. Methods Totally 120 cases of indirect inguinal hernia in our hospital from Jan. 2015 to Jan. 2018 were selected. All patients underwent laparoscopic hernia ligation and sufentanil combined with cisatracurium and propofol anesthesia. According to the random number table, they were divided into group A, B and C, 40 cases in each group. During the induction period, different doses of sufentanil (0.3?μg/kg for A group, 0.4?μg/kg for B group, 0.5?μg/kg for C group), midazolam (0.1?mg/kg) and propofol (2.0?mg/kg) were given. During the operation, 0.12 mg/(kg?h) cisbenzenesulfonatracurium and 10 mg/kg?h propofol were used for maintenance, and sufentanil was added according to the heart rate (HR). HR, SBP and SpO2 were recorded before anesthesia induction (T0), before tracheal intubation (T1), at tracheal intubation (T2), at the beginning of surgery (T3), at the establishment of pneumoperitoneum (T4), at 5 minutes after pneumoperitoneum (T5) and at tracheal extubation (T6). The anesthesia induction time, operation time, recovery time, sufentanil addition rate, adverse reactions, and postoperative Wong-Baker facial analgesia score and Ramsay sedation score were compared among the three groups. Results The induction time of anesthesia in group A was longer than that in group B and C (P?