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目的比较靶控输注异丙酚与七氟醚吸入麻醉对阻塞性睡眠呼吸暂停综合征(obstructivesleep apnea syndrome,OSAS,即鼾症)患儿血流动力学的影响及苏醒期的特点。方法选择择期行悬雍垂-腭-咽成形术(uvulopalatopharyngoplasty,UPPP)的OSAS患儿36例,随机分为靶控输注(T)与七氟醚(S)两组。T组(n=18例)诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及维库溴铵0.1mg/kg后插管,维持采用瑞芬太尼0.2μg/(kg.min)+血浆靶控输注异丙酚3μg/ml,在手术结束前5min停药。S组(n=18例)诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及维库溴铵0.1mg/kg后插管,维持采用维持采用瑞芬太尼0.2μg/(kg.min)+七氟醚(维持呼出浓度在0.8~1.2MAC)静吸复合麻醉,手术结束前5min停药。记录诱导前、诱导后、插管后、切皮后、切皮后20、40min、拔管后、拔管后20、40min的MAP、HR;两组手术时间、手术结束至拔管的时间、术中肌松药总量及术后躁动、恶心呕吐、疼痛等不良反应。结果T组患者在术中血流动力学方面比S组患者平稳,拔管时间较S组短,且术后躁动、恶心呕吐较S组发生率低(P<0.05);T组与S组患者在术后疼痛评分差异无显著性。结论靶控输注异丙酚用于鼾症患儿有较明显的临床使用价值。
Objective To compare the effects of target-controlled infusion of propofol and sevoflurane anesthesia on hemodynamics in children with obstructive sleep apnea syndrome (OSAS) and wake-up period. Methods Thirty-six patients with OSAS undergoing uvulopalatopharyngoplasty (UPPP) were randomly divided into target-controlled infusion (T) and sevoflurane (S) groups. T group (n = 18) was induced by fentanyl 2μg / kg, propofol 2.5mg / kg and vecuronium 0.1mg / kg after intubation, to maintain remifentanil 0.2μg / (kg.min ) + Plasma target controlled infusion of propofol 3μg / ml, stop 5min before the end of surgery. S group (n = 18) was induced by fentanyl 2μg / kg, propofol 2.5mg / kg and vecuronium 0.1mg / kg after intubation, to maintain the use of remifentanil 0.2μg / (kg .min) + sevoflurane (to maintain the exhaled concentration of 0.8 ~ 1.2MAC) inhalation anesthesia, stop 5min before the end of surgery. The MAP and HR were recorded before induction, after induction, after intubation, 20 and 40 minutes after skin incision, 20 and 40 minutes after extubation, and 20 and 40 minutes after extubation. The operation time, time from the end of operation to extubation, Intraoperative total muscle relaxants and postoperative agitation, nausea and vomiting, pain and other adverse reactions. Results The patients in group T were more stable in hemodynamics than those in group S, the extubation time was shorter than that in group S, and the incidence of agitation and nausea and vomiting was lower than that in group S (P <0.05) There was no significant difference in postoperative pain scores among patients. Conclusion Target controlled infusion of propofol for children with snoring has obvious clinical value.