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目的探讨瑞芬太尼复合丙泊酚在小儿心脏快通道麻醉中应用的安全性和有效性。方法选择ASAⅠ或Ⅱ级、择期行房间隔缺损(ASD)或单纯室间隔缺损(VSD)修补术的患儿32例。采用瑞芬太尼复合丙泊酚静脉泵注维持麻醉,记录各时点患儿的心率、收缩压、舒张压和平均动脉压,以及术后拔管时间、ICU停留时间。结果本组平均手术时间(140±32.6)min,体外转流时间(40±15.1)min,所有患儿均自动复跳,术后拔管时间(78.2±56)min,重插管率0%,术后ICU停留时间(18.4±9.6)h。麻醉诱导期,患儿心率、收缩压、舒张压和平均动脉压都明显下降,与基础值比较差异显著(P<0.01);麻醉维持过程中,患者的心率、收缩压、舒张压和平均动脉压均低于基础值。结论瑞芬太尼复合丙泊酚持续泵注用于ASD或VSD修补手术,麻醉过程平稳,并能有效抑制气管插管和锯胸骨等强烈刺激所致的应激反应,术后可早期拔管,符合FTCA的要求。
Objective To investigate the safety and efficacy of remifentanil combined with propofol in the pediatric cardiac fast-track anesthesia. Methods Thirty-two ASA Ⅰ or Ⅱ children undergoing elective ASD or VSD repair were enrolled in this study. Remifentanil combined with propofol was used to maintain anesthesia. The heart rate, systolic pressure, diastolic pressure and mean arterial pressure were recorded, and the time of extubation and ICU stay were recorded. Results The mean operative time (140 ± 32.6) min and the time of in vitro bypass (40 ± 15.1) min in all patients were all automatically recovered. The time of extubation was (78.2 ± 56) min, the rate of reinfusion was 0% , ICU stay after surgery (18.4 ± 9.6) h. During anesthesia induction, heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were significantly decreased in children with significant differences compared with the baseline values (P <0.01). Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure Pressure is lower than the basic value. Conclusion Remifentanil combined with propofol continuous pump injection for ASD or VSD repair surgery, stable anesthesia and can effectively inhibit tracheal intubation and saw sternum and other strong stimulation-induced stress response, postoperative early extubation , In line with the requirements of FTCA.