摘要
目的探讨麻醉深度监测丙泊酚伍用瑞芬太尼对扁桃体腺样体手术患儿血流动力学和应激反应的影响。方法选取2018年7月至2019年9月该院收治的择期行扁桃体腺样体低温等离子消融术患儿106例,随机分为观察组和对照组,每组53例。观察组以丙泊酚复合瑞芬太尼麻醉,对照组以丙泊酚复合氯胺酮麻醉。比较两组患儿麻醉诱导前(T_(1))、插管即刻(T_(2))、手术开始时(T_(3))、手术结束时(T_(4))、拔管后5 min(T_(5))时平均动脉压(MAP)、心率,血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、肾上腺素、皮质醇(Cor)、CD3^(+)T淋巴细胞、CD4^(+)辅助性T淋巴细胞、CD8^(+)抑制性T淋巴细胞水平及CD4^(+)/CD8^(+)比值等。观察两组患儿麻醉恢复时间及拔管后不良反应情况。结果两组患儿T_(2)时MAP、心率均较T_(1)时明显增加,观察组患儿麻醉维持后MAP、心率监测值均明显低于对照组,差异均有统计学意义(P<0.05);且观察组患儿以更平稳的MAP、心率持续至手术结束。两组患儿血清CRP、IL-6、TNF-α水平均随时间延长而升高,差异均有统计学意义(P<0.05)。两组患儿血清肾上腺素、Cor水平从T_(1)~T_(4)时均逐渐升高,T_(5)时回降,各时间点比较,差异均有统计学意义(P<0.05)。观察组患儿T_(3)~T_(5)时CRP、IL-6、TNF-α、肾上腺素、Cor水平均明显低于对照组,差异均有统计学意义(P<0.05)。两组患儿T_(4)、T_(5)时CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)比值均下降,CD8^(+)水平升高,与T_(1)~T_(3)时比较,差异均有统计学意义(P<0.05)。两组患儿各时间点CD3^(+)、CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)比值比较,差异均无统计学意义(P>0.05)。观察组患儿自主呼吸恢复时间、肢体恢复动作时间、停麻醉药至拔管时间均明显短于对照组,苏醒期躁动发生率低于对照组,差异均有统计学意义(P<0.05)。结论丙泊酚伍用瑞芬太尼对扁桃体腺样体手术患儿的麻醉更具有优势,血流动力学更稳定,炎症和应激反应水平更低,苏醒迅速,不良反应少,值得临床推广使用于需要全身麻醉的小儿手术中。
Objective To investigate the effects of propofol combined with remifentanil on the hemodynamics and stress response in children patients undergoing tonsillar adenoid surgery under anesthesia depth monitoring.Methods A total of 106 children patients undergoing elective low-temperature plasma ablation of tonsil and adenoid in this hospital from July 2018 to September 2019 were selected and randomly divided into the observation group and the control group,53 cases in each group.The observation group was anesthetized with propofol combined with remifentanil,and the control group was anesthetized with propofol combined with ketamine.The mean arterial pressure(MAP),heart rate(HR),serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factorα(TNF-α),epinephrine(E),cortisol(Cor),CD3^(+)T lymphocytes,CD4^(+)helper T lymphocytes,CD8^(+) inhibitory T lymphocytes and CD4^(+)/CD8^(+) ratio before anesthesia induction(T_(1)),at immediate intubation(T_(2)),start of surgery(T_(3)),end of surgery(T_(4)),and 5 min after extubation(T_(5))were compared between the two groups.The recovery time of anesthesia and the adverse reactions after extubation were observed in the two groups.Results MAP and HR at T_(2) in the two groups were significantly increased compared with those at T_(1),the MAP and HR monitoring values after anesthesia maintenance in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Moreover the children patients in the observation group continued to have more stable MAP and HR until the end of the operation.The levels of serum CRP,IL-6 and TNF-αin the two groups were increased with time extension,and the difference was statistically significant(P<0.05).The levels of serum E and Cor in the two groups were gradually increased from T_(1) to T_(4),and then decreased back at T_(5),and there were statistically significant differences among various time points(P<0.05).The levels of CRP,IL-6,TNF-α,E and Cor at T_(3)-T_(5) in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) at T_(4),T_(5) in the two groups were decreased,and the level of CD8^(+) was increased,which showed statistically significant differences compared with those at T_(1)-T_(3)(P<0.05).The levels of CD3^(+),CD4^(+) and CD4^(+)/CD8^(+) in the two groups had no statistical differences among various time points(P>0.05).In the observation group,the recovery time of spontaneous breathing,recovery time of limbs motion and time of the anesthesia withdrawal to extubation were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidence rate of agitation in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Propofol combined with remifentanil has more advantages in anesthesia for children patients with tonsil adenoid surgery,more stable hemodynamics,lower levels of inflammation and stress response,rapid recovery,fewer adverse reactions,and is worthy of clinical promotion and application in pediatric surgery requiring general anesthesia.
作者
丁洋子
张奉超
李立
刘雨梅
朱珊珊
DING Yangzi;ZHANG Fengchao;LI Li;LIU Yumei;ZHU Shanshan(Department of Anesthesiology,Affiliated Xuzhou Children′s Hospital,Xuzhou Medical University,Xuzhou,Jiangsu 221006,China;Institute of Anesthesia,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China)
出处
《重庆医学》
CAS
2022年第1期70-75,共6页
Chongqing medicine
基金
江苏省自然科学基金项目(QJA329911)。
