瑞芬太尼泵注合并喉罩通气在小儿腹腔镜疝囊高位结扎术中的临床应用

目的观察瑞芬太尼联合丙泊酚静脉泵注合并喉罩通气在小儿腹腔镜疝囊高位结扎术中应用的效果。方法选择2012年10月～2013年8月40例ASAⅠ-Ⅱ级腹腔镜疝囊高位结扎术患儿，分为瑞芬太尼组（20例）和芬太尼组（20例），诱导满意后置入喉罩，术中两组均吸入1．0％异氟烷，瑞芬太尼组持续泵入瑞芬太尼0．1～0．25μg／（min·kg）和丙泊酚40—60肛g／（min·kg）维持麻醉，芬太尼组持续泵入丙泊酚40—60μg／（min·kg），切皮前静脉缓慢注射芬太尼2μg／kg。记录诱导前（T0）、诱导后（T1）、喉罩置人后2min（T2）、放气后（T3）的平均动脉压（MAP）、心率（HR）以及术毕拔出喉罩时间、复苏时间。结果2组麻醉诱导后MAP均下降，芬太尼组更加明显（P〈0．05）。瑞芬太尼组喉罩拔出时间和复苏时间（6．3±2．2）、（14．5±5．4）min]明显短于芬太尼组（12．5±4．2）、（20．4±6．4）min]（t=-8．662、-5．382，P=0．000、0．000）。结论瑞芬太尼联合丙泊酚静脉泵注合并喉罩通气进行小儿腹腔镜疝囊高位结扎术，不但可以缩短复苏时间，而且对血流动力学影响小，是一种值得推荐的麻醉方式。

Clinical Application of Anesthesia with Remifentanil Infusion Combined Laryngeal Mask Airway Insertion for Laparoscopic High Ligation of Hernia Sac in Children

Objective To explore the efficacy of anesthesia with remifentanil infusion combined laryngeal mask airway （LMA） insertion for laparoscopic hernia repair in children. Methods A total of 40 pediatric patients undergoing laparoscopic hernia repair from October 2012 to August 2013 were randomized into remifentanil group （group R, n = 20 ） and fentanyl group （group F, n = 20）. LMA was inserted following satisfactory induction. Anesthesia was maintained to inhale 1.0% isoflurane in both groups. In group R, remifentanil 0.1 -0.25 μg/（min · kg） and propofol 40 -60 μg/（min · kg） were infused. In group F, propofol 40 -60 μg/（ min · kg） was infused and fentanyl 2 p.g/kg was injected before skin incision. The mean arterial pressure （MAP） and heart rate （HR） of patients were respectively recorded before induction （T0） , after induction （T1） , 2 minutes after LMA was placed （T2） and after pneumoperitoneum （T3）. The LMA extraction time and recovery time were also recorded. Results MAP decreased after induction in both groups, with the deduction of MAP in group F more significant （P 〈 0.05）. The LMA extraction time and recovery time were significantly shorter in Group R （6.3 ±2.2）, （14.5 ±5.4） mini than in Group F （12.5 ±4.2）, （20.4 ±6.4） mini （t = - 8. 662 and -5. 382, P = 0. 000 and 0. 000）. Conclusions The application of anesthesia with remifentanil and propofol infusion combined LMA insertion for laparoscopic hernia repair in children is safe and effective. It shortens recovery time and stabilizes hemodynamics.