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目的:观察瑞芬太尼联合依托咪酯复合麻醉用于小儿无痛胃肠镜检查中的安全性和有效性。方法:行胃肠镜检查或治疗的患儿120例(ASAⅠ-Ⅱ级),随机分为瑞芬太尼联合依托咪酯组(RE组)和氯胺酮联合依托咪酯组(KE组)各60例。2组均静脉给予依托咪酯2 mg/kg,待患儿入睡后,RE组以瑞芬太尼0.1μg/(kg·min)和依托咪酯0.3μg/(kg·min)泵注维持。KE组以氯胺酮20μg/(kg·min)和依托咪酯0.3μg/(kg·min)泵注维持麻醉.对比观察2组患儿麻醉中平均动脉压(MAP)、心率(HR)、呼吸(RR)、脉搏氧饱和度(SpO_2)情况,清醒和恢复时间,镇静效果,不良反应等。结果:RE组患儿胃肠镜置入前及置入后5 min MAP、HR改变无明显变化(P>0.05),KE组置入后5 min MAP升高,HR增快,与RE组比较差异有统计学意义(P<0.05);镇静质量模拟评分(VAS)评分≤2分者,RE组为52例,KE组为41例,RE组高于KE组(P<0.05),RE组苏醒时间和恢复时间明显短于KE组,两组比较差异有统计学意义(P<0.01或P<0.05)。结论:瑞芬太尼联合依托咪酯可安全地用于小儿无痛胃肠镜检查,和氯胺酮联合依托咪酯比较,瑞芬太尼联合依托咪酯麻醉组术中血流动力学指标更平稳,苏醒及恢复更快,术中及术后不良反应相对较少。
Objective: To observe the safety and efficacy of remifentanil combined with etomidate anesthesia for pediatric painless gastrointestinal endoscopy. Methods: One hundred and twenty children (ASAⅠ-Ⅱ grade) undergoing gastrointestinal endoscopy or treatment were randomly divided into two groups: the remifentanil combined etomidate group (RE group) and the ketamine combined etomidate group (KE group) example. Both groups were given intravenous etomidate 2 mg / kg. After the children fell asleep, the RE group was infused with remifentanil 0.1 μg / (kg · min) and etomidate 0.3 μg / (kg · min). The rats in KE group were anesthetized by ketamine (20μg / (kg · min) and etomidate 0.3μg / (kg · min)), and the mean arterial pressure (MAP), heart rate RR), pulse oxygen saturation (SpO2), awake and recovery time, sedative effect, adverse reactions and so on. Results: There were no significant changes in MAP and HR in children with RE before and after 5 min of reperfusion (P> 0.05). The MAP increased and HR increased 5 min after admission in RE group, compared with RE group The difference was statistically significant (P <0.05). In VAS score ≤2, there were 52 cases in RE group, 41 cases in KE group, and higher in RE group than in KE group (P <0.05) Recovery time and recovery time were significantly shorter than KE group, the difference between the two groups was statistically significant (P <0.01 or P <0.05). Conclusion: Remifentanil combined with etomidate can be safely used in children with painless gastrointestinal endoscopy, ketamine and etomidate compared with remifentanil combined etomidate anesthesia group intraoperative hemodynamic indicators more stable , Recovery and faster recovery, intraoperative and postoperative adverse reactions are relatively small.