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丙泊酚联合舒芬太尼对小儿全身麻醉下无痛胃镜检查及血流动力学的影响。

Effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia.

作者信息

Wang Yujue, Yang Haiyang, Cai Weiwei, Ni Huanhuan

机构信息

Department of Anesthesiology, Children's Hospital of Nanjing Medical University Nanjing 210011, Jiangsu, China.

出版信息

Am J Transl Res. 2023 Jul 15;15(7):4942-4950. eCollection 2023.

Abstract

OBJECTIVE

To determine the effects of propofol combined with sufentanil on painless gastroscopy and hemodynamics in children under general anesthesia.

METHODS

The data of 98 children who received painless gastroscopy in the Children's Hospital of Nanjing Medical University from May 2022 and November 2022 were analyzed retrospectively. Patients anesthetized with propofol (1.5-2 mg/kg) combined with sufentanil (0.03-0.05 μg/kg) were assigned to a study group (n=52), and patients anesthetized with propofol (1.5-2 mg/kg) combined with fentanyl (0.3-0.5 µg/kg) were included in a control group (n=46). The changes in hemodynamic levels (mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) at T0 (before anesthesia), T1 (1 min after anesthesia induction), T2 (start of examination), T3 (2 min after the start of examination), and T4 (end of examination) in the two groups were analyzed and compared. The Ramsay sedation score was adopted to evaluate the sedation of the two groups at the anesthesia recovery and at 1 h and 2 h after the anesthesia recovery. The anesthetic effects (time to loss of consciousness, eye opening, and recovery of orientations) of the two groups were analyzed and compared. The excellent and good anesthesia outcomes, hospitalization time and dosage of propofol were compared between the two groups, and the adverse reactions in the two groups during and after the examination were analyzed.

RESULTS

At T0, the two groups were not significantly different in the levels of MAP, HR and SpO2 (P>0.05), but at T1, T2, T3, and T4, the study group showed a significantly higher MAP level than the control group (P<0.05). At T1 and T3, the study group exhibited a significantly higher HR level than the control group (P<0.05), and at T2 and T4, the HR level of the two groups was not greatly different (P>0.05). The SpO2 levels at T0, T1, T2, T3, and T4 were not greatly different between the two groups (P>0.05). There was no significant difference in Ramsay score between the two groups at anesthesia recovery and at 1 h and 2 h after the anesthesia recovery (P>0.05). Additionally, the study group experienced significantly earlier time to loss of consciousness, eye opening, and recovery of orientations than the control group (P<0.05). The number of patients with excellent anesthetic outcome in the study group was notably higher than that in the control group (P<0.05). Compared with the control group, the study group consumed less propofol, experienced shorter hospitalization time, and showed a notably lower incidence of adverse reactions (P<0.05).

CONCLUSION

For children undergoing painless gastroscopy under general anesthesia, sufentanil combined with propofol can deliver better anesthetic effect than propofol combined with fentanyl, with less effect on hemodynamics and fewer gastroscopy-related adverse reactions.

摘要

目的

探讨丙泊酚联合舒芬太尼用于小儿全身麻醉下无痛胃镜检查时对其血流动力学的影响。

方法

回顾性分析2022年5月至2022年11月在南京医科大学附属儿童医院行无痛胃镜检查的98例患儿的资料。将丙泊酚(1.5 - 2 mg/kg)联合舒芬太尼(0.03 - 0.05 μg/kg)麻醉的患儿设为研究组(n = 52),将丙泊酚(1.5 - 2 mg/kg)联合芬太尼(0.3 - 0.5 μg/kg)麻醉的患儿设为对照组(n = 46)。分析比较两组患儿在麻醉前(T0)、麻醉诱导后1 min(T1)、检查开始时(T2)、检查开始后2 min(T3)、检查结束时(T4)的血流动力学水平(平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO2))的变化。采用Ramsay镇静评分评估两组患儿麻醉苏醒时及麻醉苏醒后1 h、2 h的镇静情况。分析比较两组患儿的麻醉效果(意识消失时间、睁眼时间及定向力恢复时间)。比较两组患儿麻醉效果优良率、住院时间及丙泊酚用量,并分析两组患儿检查中及检查后的不良反应。

结果

T0时,两组患儿MAP、HR及SpO2水平差异无统计学意义(P > 0.05);T1、T2、T3及T4时,研究组患儿MAP水平显著高于对照组(P < 0.05)。T1及T3时,研究组患儿HR水平显著高于对照组(P < 0.05),T2及T4时,两组患儿HR水平差异无统计学意义(P > 0.05)。两组患儿T0、T1、T2、T3及T4时SpO2水平差异无统计学意义(P > 0.05)。两组患儿麻醉苏醒时及麻醉苏醒后1 h、2 h的Ramsay评分差异无统计学意义(P > 0.05)。此外,研究组患儿意识消失时间、睁眼时间及定向力恢复时间均显著早于对照组(P < 0.05)。研究组患儿麻醉效果优良率显著高于对照组(P < 0.05)。与对照组比较,研究组患儿丙泊酚用量少,住院时间短,不良反应发生率显著降低(P < 0.05)。

结论

小儿全身麻醉下无痛胃镜检查时,舒芬太尼联合丙泊酚较丙泊酚联合芬太尼麻醉效果好,对血流动力学影响小,胃镜检查相关不良反应少。

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