探究七氟烷吸入复合瑞芬太尼麻醉在小儿腹腔镜腹股沟疝修补术中的应用效果。

选取2020年6月至2022年12月，鄂尔多斯市中心医院收治的100例行小儿腹股沟疝修补术患者，随机数字表法将患儿分为对照组与观察组，各50例。2组患儿均接受腹腔镜腹股沟疝修补术治疗，对照组患儿予以丙泊酚复合瑞芬太尼麻醉，观察组患儿予以七氟烷吸入复合瑞芬太尼麻醉。比较2组患儿入室前（T0）、切皮时（T1）、手术开始5 min（T2）、10 min（T3）及术毕即刻（T4）的血流动力学指标[心率、平均动脉压（MAP）]，术前、术后的应激指标[皮质醇、促肾上腺糖皮质激素（ACTH）、C反应蛋白（CRP）]变化，术后6、12、24、48 h疼痛程度（NRS评分法）、Ramsay镇静量表评分（RSS），以及躁动情况。

与T0时刻比较，对照组在T1、T2、T3时的心率均显著降低（P<0.05），而观察组T1、T2、T3、T4时刻的心率变化不明显（P>0.05）。2组患者的心率水平比较，差异有统计学意义（F_组间=446.800，P_组间<0.001；F_时间=62.220，P_时间<0.001；F_交互=63.960，P_交互<0.001）。与T0时刻比较，对照组T1、T2、T3、T4各时刻的MAP降低（P<0.05），观察组T1、T2、T3、T4各时刻的MAP变化不明显（P>0.05），2组患者MAP水平比较，差异有统计学意义（F_组间=62.540，P_组间<0.001；F_时间=9.275，P_时间<0.001；F_交互=9.614，P_交互<0.001）。术后2组患者的皮质醇、ACTH及CRP均显著升高（P<0.05），且对照组更高（P<0.05）。对照组术后6、12、24、48 h NRS评分均高于观察组（F_组间= 434.100，P_组间<0.001；F_时间=1.435，P_时间=0.232；F_交互=2.263，P_交互=0.081）；2组患儿术后各时间段RSS评分比较，差异均无统计学意义（F_组间=0.221，P_组间=0.639；F_时间=2.201，P_时间=0.088；F_交互= 0.669，P_交互=0.572）。2组患儿躁动发生率差异无统计学意义（P>0.05）。

小儿腹股沟疝修补术应用七氟烷复合瑞芬太尼麻醉利于患儿血流动力学平衡，降低患儿应激反应。

To investigate the application effect of sevoflurane inhalation combined with remifentanil anesthesia in laparoscopic inguinal hernia repair in children.

100 children who underwent laparoscopic inguinal hernia surgery in Ordos Center Hospital from June 2020 to December 2022 were selected, and divided into the control group and the observation group using the random number table method, with 50 cases in each group. Both groups underwent laparoscopic inguinal hernia repair. Children in the control group were anesthetized with propofol combined with remifentanil, and children in the observation group were anesthetized with sevoflurane inhalation combined with remifentanil. The two groups were compared on hemodynamic indicators [heart rate and mean arterial pressure (MAP)] before entering the room (T0), at the time of skin incision (T1), 5 min after the beginning of surgery (T2), 10 min after the beginning of surgery (T3), and the end of surgery (T4), stress indicators [cortisol, adrenocorticotropic hormone (ACTH) and C-reactive protein (CRP)] before and after surgery, pain degrees [Numerical Rating Scale (NRS) scores] and Ramsay Sedation Scale (RSS) scores at 6, 12, 24, and 48 h after surgery, and agitation.

Heart rate of the control group at T1, T2 and T3 was significantly lower compared to T0 (P<0.05). Compared to T0, there was no statistically significant difference in heart rate of the observation group at T1, T2, T3 and T4 (P>0.05). There were statistically significant differences in heart rate between the two groups in terms of inter-group effect, time effect, and interaction effect (F=446.800, 62.220, 63.960, P<0.001, <0.001, <0.001). MAP of the control group was significantly lower at T1, T2, T3 and T4 than at T0 (P<0.05). Compared to T0, there was no statistically significant difference in MAP of the observation group at T1, T2, T3 and T4 (P>0.05). There were statistically significant differences in MAP between the two groups in terms of inter-group effect, time effect, and interaction effect (F=62.540, 9.275, 9.614, P<0.001, <0.001, <0.001). Cortisol, ACTH and CRP increased after surgery in both groups (P<0.05), and were higher in the control group (P<0.05). The control group had higher NRS scores than the observation group at 6, 12, 24, and 48 h after surgery (F=434.100, 1.435, 2.263, P<0.001, =0.232, 0.081 for inter-group effect, time effect, and interaction effect). There was no statistically significant difference in RSS scores between the two groups at different time after surgery (F=0.221, 2.201, 0.669, P=0.639, 0.088, 0.572 for inter-group effect, time effect, and interaction effect). There was no statistically significant difference in the incidence of agitation between the two groups (P>0.05).

The application of sevoflurane inhalation combined with remifentanil anesthesia in pediatric inguinal hernia repair is beneficial to maintain hemodynamic stability of children, and reduce the incidence rates of stress response.