Abstract:

Objective　To observe the efficacy and safety of sub-dose remifentanil combined with propofol in pediatric intravenous anesthesia maintenance. Methods　This was a randomized controlled trial. A total of 125 children who underwent surgery in the First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2023 were prospectively selected as the study objects and were divided into 3 groups by drawing lots. In the conventional dose group, the ratio of boys to girls was 22/20, the age was (9.45±1.23) years old, and the types of surgery were as follows: 22 cases of hernia surgery, 10 cases of tonsillectomy, and 10 cases of orthopedic surgery. In the sub-dose group, the ratio of boys to girls was 20/21, the age was (9.33±1.16) years old, and the types of surgery were as follows: 22 cases of hernia surgery, 10 cases of tonsillectomy, and 9 cases of orthopedic surgery. In the low-dose group, the ratio of boys to girls was 23/19, and the age was (9.52±1.31) years old, and the types of surgery were as follows: 21 cases of hernia surgery, 11 cases of tonsillectomy, and 10 cases of orthopedic surgery. The conventional dose group was given 1.00 μg/kg remifentanil combined with propofol to maintain anesthesia, the low-dose group was given 0.25 μg/kg remifentanil combined with propofol to maintain anesthesia, and the sub-dose group was given 0.50 μg/kg remifentanil combined with propofol to maintain anesthesia. The changes in basic physical signs during the perioperative period, postoperative recovery, pain relief, and anesthesia-related adverse reactions of the 3 groups were compared. χ² test, F test, and independent sample t test were used. Results　Before surgery, there were no statistically significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the 3 groups (both P>0.05). Ten min after anesthesia, the HR and MAP of the sub-dose group were (73.45±5.22) beats/min and (79.11±5.33) mmHg (1 mmHg = 0.133 kPa), which were higher than those of the conventional dose group [(70.14±5.17) beats/min and (76.62±5.41) mmHg] (both P<0.05), but there were no statistically significant differences compared with those of the low dose group [(74.49±5.23) beats/min and (80.25±5.41) mmHg] (both P>0.05). At the time of tracheal intubation, the HR and MAP of the sub-dose group were (80.33±5.26) beats/min and (81.25±5.45) mmHg, which were lower than those of the low-dose group [(83.28±5.41) beats/min and (84.49±5.18) mmHg] (both P<0.05), but there were no statistically significant differences compared with those of the conventional dose group [(79.45±5.31) beats/min and (80.44±5.32) mmHg] (both P>0.05). Thirty min after intubation, the HR and MAP of the sub-dose group were (79.45±10.13) beats/min and (80.23±10.16) mmHg, which were higher than those of the conventional dose group [(72.15±10.49) beats/min and (73.22±10.25) mmHg] but were lower than those of the low dose group [(86.39±10.22) beats/min and (87.24±10.18) mmHg] (all P<0.05). At the end of surgery, the HR and MAP of the sub-dose group were (80.24±10.32) beats/min and (83.39±10.47) mmHg, which were higher than those of the conventional dose group [(74.11±10.46) beats/min and (77.25±10.35) mmHg], but were lower than those of the low dose group [(87.15±10.36) beats/min and (90.72±10.18) mmHg] (all P<0.05). After surgery, the recovery time of the sub-dose group [(11.45±5.46) min] was shorter than that of the conventional dose group [(14.28±5.33) min] (P<0.05), and there was no statistically significant difference compared with that of the low dose group [(10.49±5.26) min] (P>0.05). The VAS score of the sub-dose group [(3.29±1.27) points] was lower than that of the low-dose group [(4.17±1.34) points] (P<0.05), but there was no statistically significant difference compared with that of the conventional dose group [(3.18±1.45) points] (P>0.05). The incidence of anesthesia-related adverse reactions in the sub-dose group was 9.76% (4/41), which was lower than that in the conventional dose group [28.57% (12/42)], with a statistically significant difference (P<0.05); it was slightly higher than that in the low-dose group [7.14% (3/42)], with no statistically significant difference (P>0.05). Conclusion　The use of 0.50 μg/kg remifentanil combined with propofol in pediatric intravenous anesthesia maintenance can effectively maintain the stability of basic signs in children during surgery, and produce significant analgesic effect, which has positive significance in promoting the children's recovery and reducing the risk of postoperative anesthesia-related adverse reactions.

Key words:

Remifentanil, Propofol, Pediatric intravenous anesthesia, Anesthesia effect, Anesthesia safety

摘要：

目的　观察亚剂量瑞芬太尼联合丙泊酚在小儿静脉麻醉维持中的应用效果及安全性。方法　本文为随机对照试验，前瞻性选取2021年1月至2023年1月期间至南阳医学高等专科学校第一附属医院接受手术的125例患儿为研究对象，应用抽签法将其分为3组。常规剂量组中患儿男女比为22/20、年龄（9.45±1.23）岁，手术类型：22例为疝气手术，10例为扁桃体切除术，10例为骨科手术；亚剂量组中患儿男女比为20/21、年龄（9.33±1.16）岁，手术类型：22例为疝气手术，10例为扁桃体切除术，9例为骨科手术；低剂量组中患儿男女比为23/19、年龄（9.52±1.31）岁，手术类型：21例为疝气手术，11例为扁桃体切除术，10例为骨科手术。常规剂量组术中予以1.00 μg/kg瑞芬太尼配合丙泊酚维持麻醉，低剂量组术中予以0.25 μg/kg瑞芬太尼配合丙泊酚维持麻醉，亚剂量组术中予以0.50 μg/kg瑞芬太尼配合丙泊酚维持麻醉。比较3组患儿围手术期基础体征变化情况，术后苏醒、镇痛情况及麻醉相关不良反应发生情况。采用χ²检验、F检验、独立样本t检验。结果　术前，3组患儿的心率（HR）、平均动脉压（MAP）差异均无统计学意义（均P>0.05）；麻醉后10 min，亚剂量组的HR为（73.45±5.22）次/min，MAP为（79.11±5.33）mmHg（1 mmHg=0.133 kPa），高于常规剂量组［（70.14±5.17）次/min、（76.62±5.41）mmHg］（均P<0.05），与低剂量组［（74.49±5.23）次/min、（80.25±5.41）mmHg］比较差异均无统计学意义（均P>0.05）；气管插管时，亚剂量组的HR为（80.33±5.26）次/min，MAP为（81.25±5.45）mmHg，低于低剂量组［（83.28±5.41）次/min、（84.49±5.18）mmHg］（均P<0.05），与常规剂量组［（79.45±5.31）次/min、（80.44±5.32）mmHg］比较差异均无统计学意义（均P>0.05）；插管后30 min，亚剂量组的HR为（79.45±10.13）次/min，MAP为（80.23±10.16）mmHg，高于常规剂量组［（72.15±10.49）次/min、（73.22±10.25）mmHg］、低于低剂量组［（86.39±10.22）次/min、（87.24±10.18）mmHg］（均P<0.05）；术毕，亚剂量组的HR为（80.24±10.32）次/min，MAP为（83.39±10.47）mmHg，高于常规剂量组［（74.11±10.46）次/min、（77.25±10.35）mmHg］、低于低剂量组［（87.15±10.36）次/min、（90.72±10.18）mmHg］（均P<0.05）。术后，亚剂量组的苏醒时间［（11.45±5.46）min］短于常规剂量组［（14.28±5.33）min］（P<0.05），与低剂量组［（10.49±5.26）min］比较差异无统计学意义（P>0.05）；亚剂量组的视觉模拟评分法（VAS）评分［（3.29±1.27）分］低于低剂量组［（4.17±1.34）分］（P<0.05），与常规剂量组［（3.18±1.45）分］比较差异无统计学意义（P>0.05）。亚剂量组的麻醉相关不良反应发生率9.76%（4/41）低于常规剂量组28.57%（12/42），差异有统计学意义（P<0.05）；略高于低剂量组7.14%（3/42），差异无统计学意义（P>0.05）。结论　在小儿静脉麻醉维持中采用0.50 μg/kg亚剂量瑞芬太尼配合丙泊酚可在有效维持患儿术中基础体征稳定，同时产生显著的镇痛效果，对促进患儿苏醒、降低术后麻醉相关不良反应发生风险均有积极意义。

关键词:

瑞芬太尼, 丙泊酚, 小儿静脉麻醉, 麻醉效果, 麻醉安全性