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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 425 -428. doi: 10.3877/cma.j.issn.1674-392X.2022.04.012

临床论著

瑞芬太尼联合右美托咪定在腹腔镜疝囊高位结扎术中的麻醉效果及对并发症的影响
张宏江1,†(), 刘雪莲2, 郑立3   
  1. 1. 519000　广东省，珠海市中西医结合医院麻醉科
    2. 519000　广东省，珠海市中西医结合医院儿科
    3. 519000　广东省，珠海市中西医结合医院普通外科
  • 收稿日期:2021-12-13 出版日期:2022-08-18
  • 通信作者: 张宏江
  • 基金资助:
    珠海市科技计划项目(ZH22036201210112PWC)

Effect of remifentanil combined with dexmedetomidine in laparoscopic high ligation of hernia sac in children and its influence on complications

Hongjiang Zhang1,†(), Xuelian Liu2, Li Zheng3   

  1. 1. Department of Anesthesiology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, Guangdong Province, China
    2. Department of Pediatrics, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, Guangdong Province, China
    3. Department of General Surgery, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai 519000, Guangdong Province, China
  • Received:2021-12-13 Published:2022-08-18
  • Corresponding author: Hongjiang Zhang
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引用本文：

张宏江, 刘雪莲, 郑立. 瑞芬太尼联合右美托咪定在腹腔镜疝囊高位结扎术中的麻醉效果及对并发症的影响[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(04): 425-428.

Hongjiang Zhang, Xuelian Liu, Li Zheng. Effect of remifentanil combined with dexmedetomidine in laparoscopic high ligation of hernia sac in children and its influence on complications[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(04): 425-428.

目的

分析瑞芬太尼联合右美托咪定在腹腔镜疝囊高位结扎手术腹股沟疝患儿的麻醉效果及对并发症的影响。

方法

选择2017年1月至2021年1月珠海市中西医结合医院收治的98例腹股沟疝患儿作为研究对象，研究组（49例）采用瑞芬太尼联合右美托咪定麻醉，对照组（49例）采用常规麻醉，对比入室（T0）、置喉罩（T1）、手术开始（T2）、术毕（T3）时段2组患儿的心率、平均动脉压（MAP）、呼气末二氧化碳分压（PETCO2）及脑电双频指数（BIS），记录2组患儿的拔喉罩时间、呼吸恢复时间、完全清醒时间及并发症发生情况。

结果

相比T0时间点，T1时间点的2组患儿心率水平、MAP水平、BIS指数明显降低，研究组明显高于对照组（P<0.05），2组患儿PETCO2水平较T0均明显升高，但组间对比无统计学意义（P>0.05）。T2时间点的2组患儿心率水平、MAP水平、BIS指数明显降低，研究组明显高于对照组（P<0.05），2组患儿的PETCO2水平较T0均明显升高，而研究组明显低于对照组（P<0.05）。T3时间点2组患儿心率水平、BIS指数明显降低，研究组明显高于对照组（P<0.05），MAP水平低于T0水平，但组间对比无差异（P>0.05）；2组患儿的PETCO2水平较T0均明显升高，而研究组明显低于对照组（P<0.05）。研究组患儿的拔喉罩时间、呼吸恢复时间、完全清醒时间均明显低于对照组（P<0.05）。研究组患儿的呛咳及咽喉疼痛发生率稍低于对照组（P>0.05），而躁动、呼吸抑制及恶心呕吐发生率明显低于对照组（P<0.05）。

结论

瑞芬太尼联合右美托咪定可有效保持腹股沟疝患儿腹腔镜疝囊高位结扎术中的血流动力学稳定，具有良好的镇静及麻醉后复苏效果，并可减少围手术期并发症的发生。

关键词: 瑞芬太尼, 右美托咪定, 疝，腹股沟, 腹腔镜, 疝囊高位结扎术, 儿童
Objective

To analyze the effect of remifentanil combined with dexmedetomidine in laparoscopic high ligation of hernia sac in children and its effect on complications.

Methods

A total of 98 children with inguinal hernia who were admitted to our hospital from January 2017 to January 2021 were selected as the study subjects. The study group (49 cases) received remifentanil combined with dexmedetomidine anesthesia, and the control group (49 cases) received conventional anesthesia. The HR, MAP, PETCO2 and BIS were compared between the two groups at different time periods, and the time of laryngeal mask removal, respiratory recovery time, full awake time and complications were recorded between the two groups.

Results

Compared with the T0 time point, the heart rate level, MAP level and BIS index of the two groups were significantly decreased at the T1 time point, and the study group was significantly higher than the control group (P<0.05), while the PETCO2 level of the two groups was significantly higher than that of the T0 time point, but the comparison between the two groups was not statistically significant (P>0.05). At T2 time point, the heart rate, MAP level and BIS index of the two groups were significantly decreased, and the study group was significantly higher than the control group (P<0.05), while the PETCO2 level of the two groups was significantly higher than that of the T0 group, while the study group was significantly lower than the control group (P<0.05). At T3 time point, the heart rate and BIS index of the two groups significantly decreased, and the study group was significantly higher than the control group (P<0.05), and the MAP level was lower than the T0 level, but there was no difference between the two groups (P>0.05). The PETCO2 level of the two groups was significantly higher than that of the T0. The study group was significantly lower than the control group (P<0.05). The time of laryngeal mask extraction, respiratory recovery time and full awake time in the study group were significantly lower than those in the control group (P<0.05). The incidence of choking and throat pain in the study group was slightly lower than that in the control group (P>0.05), while the incidence of agitation, respiratory depression, nausea and vomiting was significantly lower than that in the control group (P<0.05).

Conclusion

Remifentanil combined with dexmedetomidine can effectively maintain hemodynamic stability in laparoscopic high ligation of inguinal hernia sac in children with inguinal hernia, has good sedation and post-anesthesia resuscitation effects, and reduces the incidence of perioperative complications, which is worthy of clinical promotion.

Key words: Remifentanil, Dexmedetomidine, Hernia, inguinal, Laparoscope, High ligation of hernia sac, Child
表1 2组患儿的心率水平（次/min，±s）
组别 例数 T0 T1 T2 T3
研究组 49 93.48±3.52 84.03±1.96* 88.81±2.50* 91.08±3.06*
对照组 49 93.12±3.09 82.34±2.59* 85.35±1.95* 89.00±2.51*
t值   0.54 3.64 7.64 3.68
P值   0.59 0.00 0.00 0.00
表2 2组患儿的平均动脉压水平（mmHg，±s）
组别 例数 T0 T1 T2 T3
研究组 49 81.22±4.13 73.40±2.10* 76.92±1.82* 79.68±3.20*
对照组 49 82.31±2.40 71.51±2.25* 74.60±1.83* 78.45±3.13*
t值   1.60 4.30 6.29 1.92
P值   0.11 0.00 0.00 0.06
表3 2组患儿的呼气末二氧化碳分压水平（mmHg，±s）
组别 例数 T0 T1 T2 T3
研究组 49 47.82±3.70 51.21±3.84* 56.40±3.11* 52.36±3.01*
对照组 49 47.15±3.80 54.08±2.46* 59.73±2.65* 56.71±2.97*
t值   0.88 4.41 5.70 7.20
P值   0.38 0.00 0.00 0.00
表4 2组患儿的脑电双频谱指数水平（±s）
组别 例数 T0 T1 T2 T3
研究组 49 90.31±3.04 74.05±3.18* 63.16±3.80* 69.07±3.17*
对照组 49 90.41±3.63 69.58±3.36* 58.19±4.18* 65.49±3.46*
t值   0.15 6.76 6.16 5.34
P值   0.88 0.00 0.00 0.00
表5 2组患儿的拔喉罩时间、呼吸恢复时间、完全清醒时间（min，±s）
组别 例数 拔喉罩时间 呼吸恢复时间 完全清醒时间
研究组 49 7.04±1.48 5.77±1.02 6.87±2.02
对照组 49 9.68±1.58 7.18±1.62 9.62±2.22
t值   8.54 5.16 6.41
P值   0.00 0.00 0.00
表6 2组患儿的并发症情况[例（%）]
组别 例数 呛咳 躁动 呼吸抑制 恶心呕吐 咽喉疼痛
研究组 49 9(18.37) 4(8.16) 6(12.24) 7(14.29) 19(38.78)
对照组 49 16(32.65) 12(24.49) 15(30.61) 17(34.69) 22(44.90)
χ2值   2.63 4.78 4.91 5.52 0.38
P值   0.11 0.03 0.03 0.02 0.54
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