微创医学

目的探讨小剂量舒芬太尼、七氟烷静吸复合全麻在经胸非体外循环下先心封堵术的麻醉效果和术后苏醒质量。方法择期行食道超声引导下经胸微创先心封堵术患儿73例，年龄1～6岁，诊断为先天性心脏病房间隔缺损、室间隔缺损或肺动脉导管未闭。随机分为观察组（A组，36例）和对照组（B组，37例），两组均用舒芬太尼1 μg/kg、丙泊酚4 mg/kg诱导；A组以七氟烷吸入、间断静脉注射舒芬太尼维持麻醉；B组以丙泊酚、瑞芬太尼持续静脉微泵输注维持麻醉。记录麻醉诱导前后、手术开始前、缺损封堵即时、封堵后和手术结束时的收缩压（SBP）、舒张压（DBP）和心率（HR）变化；记录患儿术后苏醒时间、拔管时间、恢复室停留时间以及苏醒期躁动、呛咳、呕吐等情况的发生率。结果两组术中脑电双清指数（BIS）维持在40～60之间，麻醉效果满意，各时点SBP、DBP和HR较平稳，两组比较差异无统计学意义（P＞0.05）。A、B两组术后苏醒时间、拔管时间和在恢复室停留时间分别为（9.50±1.56）min和（12.39±1.93）min、（11.41±2.33）min和（15.22±2.38）min、（15.57±2.28）min和（19.57±2.44）min，A组均显著短于B组，差异有统计学意义（P＜0.05）。A组躁动评分（0.94±0.79）显著低于B组（1.95±0.74），差异有统计学意义（P＜0.05）。结论小剂量舒芬太尼复合七氟烷静吸全麻和丙泊酚、瑞芬太尼全凭静脉麻醉用于经胸先心封堵术均可提供较满意的麻醉效果，小剂量舒芬太尼复合七氟烷静吸全麻组患儿术后苏醒质量优于全凭静脉麻醉组。【关键词】舒芬太尼；七氟烷；丙泊酚；瑞芬太尼；先心封堵术；苏醒质量

Objective To investigate the anesthetic efficacy and quality of recovery of low-dose intravenous sufentanyl combined with sevoflurane inhalation anesthesia in transthoracic occlusion without cardiopulmonary bypass for congenital heart disease. Methods 73 children aged 1 to 6 years underwent selective transesophageal echocardiography guided minimally invasive transthoracic occlusion. 73 patients were diagnosed as atrial septal defect, ventricular septal defect or patent ductus arteriosus, and were randomly divided into observation group (group A, n=36) and control group (group B, n=37). Anesthesia was induced with sufentanil 1 μg/ kg and propofol 4mg / kg in all of cases. For anesthetic maintenance, the patients in group A accepted sevoflurane inhalation combined with interval intravenous sufentanil, and the patients in group B accepted continuous intravenous infusion propofol and remifentanil. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were monitored before and after anesthetic induction, before surgery, at the instant of occlusion, after occlusion and while surgery finished. The time to awakening and extubation, recovery room stay and the incidence of agitation, choking and vomiting were also recorded. Results The BIS during surgery maintained 40 to 60. SBP, DBP and HR were relatively stable in both groups at each time point (P＞0.05). The time to awakening, the time to extubation and the recovery room stay in group A ［(9.5±1.56) min, (11.41±2.33) min and (15.57 ± 2.28) min, respectively］ were shorter than those in group B ［(12.39±1.93) min, (15.22±2.38) min and (19.57±2.44) min, respectively］ (P＜0.05). Agitation scale in group A was significantly lower than that in group B ［(0.94 ± 0.79) vs (1.95±0.74), P＜0.05］. Conclusion Both low-dose intravenous sufentanyl combined with sevoflurane inhalation anesthesia and propofol combined with remifentanil for total intravenous anesthesia can acquire satisfied anesthesia efficacy in transthoracic occlusion for congenital heart disease. The quality of recovery in the group accepted intravenous sufentanyl combined with sevoflurane inhalation anesthesia is better than that in the group of total intravenous anesthesia.