不同濃度七氟醚對小兒全麻蘇醒期躁動發生率的影響

[摘要] 目的 探討不同濃度的七氟醚對小兒全麻蘇醒期躁動發生率的影響。 方法 選擇擇期在全麻下行小兒骨科、會陰或下腹部手術患兒88例，隨機分成A、B兩組，每組各44例。所有患兒術前均不給藥。采用面罩吸入濃度為1%～7%七氟醚+1.5%氧氣作全麻誘導，至睫毛反應消失。開放靜脈通道后即泵入瑞芬太尼。A、B兩組患者呼氣末的七氟醚濃度分別維持在0.5最低肺泡有效濃度（MAC）、1 MAC，監測各項生命體征，維持患兒輔助呼吸及呼氣末CO2（ETCO2）。觀察兩組患者麻醉平穩、呼吸抑制的程度、血流動力學的穩定性、藥物用量和蘇醒情況。結果 兩組患者術中麻醉效果佳，血流動力學穩定。A組患者蘇醒期躁動發生率為11.3%（5/44），顯著低于B組的36.4%（16/44），兩者比較差異有統計學意義（P<0.05）。兩組間的睜眼時間及離室時間的比較差異均有統計學意義（P<0.05），兩組患者七氟醚及瑞芬太尼用量比較差異有統計學意義（P<0.01），而兩組的體動反應、呼吸抑制發生例數及手術時間比較差異無統計學意義（P>0.05）。 結論 低濃度七氟醚聯合瑞芬太尼應用于小兒吸入復合麻醉的麻醉效果平穩，蘇醒快，安全性高，躁動發生率較高濃度七氟醚低，且可減少藥物用量。

[關鍵詞] 濃度；七氟醚；小兒全麻；躁動

[中圖分類號] R614.2+1 [文獻標識碼] B [文章編號] 2095-0616（2012）22-92-02

Effects of different concentrations of sevoflurane on the agitation incidence in pediatric anesthesia

WU Wenjun

Department of Anesthesia，People's Hospital in Dongxihu District of Wuhan，Wuhan 430040，China

[Abstract] Objective To investigate the influence of different concentrations of sevoflurane on the agitation incidence in pediatric anesthesia. Methods 88 cases of children who need pediatric anesthesia surgeries including orthopedic surgeries，surgeries on perineum and the lower abdomen were randomly divided into two groups（group A and group B），44 cases in each group.All patients have not received drug before surgery.Anesthrsia was induced by 1% to 7% sevoflurane and 1.5% oxygen through mask till eyelash loss of response，and pump in remifentanil through venous channel.The concentration of sevoflurane in group A was maintained at 0.5 minimum alveolar concentration of each agent througkout surgery while 1 minimum alveolar concentration in group B.Vital signs were observed and assisted breathing as well as end-tidal CO2（ETCO2） were maintained.Anesthesia stability，the degree of respiratory depression，hemodynamic stability，drug dosage and the situation among awake were recorded. Results The effects of both groups were satisfying and hemodynamic condition was stable.Agitation incidence was 11.3%（5/44）in group A，which was significantly lower than 36.4% of group B.Both time of eyes-opening and time of leaving the operating room of the two groups were significantly different（P<0.05），so as the dosages of sevoflurane and remifentanil（P<0.01）.But cases of movement in response and respiratory depression were of no significant difference（P>0.05） between group A and B. Conclusion The effect of the low concentration of sevoflurane combined with remifentanil in pediatric anesthesia was better than the high concentration because it provided quicker emergence，safety and lower agitation incidence.

[Key words] Concentration；Sevoflurane；Pediatric anesthesia；Agitation

七氟醚是近年廣泛應用于臨床的吸入性麻醉藥，具有誘導迅速、蘇醒恢復快、過程平穩、對呼吸系統及循環系統影響較小的特點，但常伴隨術后譫妄及躁動，七氟醚在小兒麻醉蘇醒期躁動發生率可達80%。瑞芬太尼因膽堿酯酶的水解消除使其降解迅速且可減低吸入性麻醉藥的最低肺泡有效濃度（MAC）[1]。……