标题：七氟烷联合丙泊酚在儿童扁桃体切除术中的麻醉效果及其对应激反应和苏醒质量的影响

      作者：毕星，马亚芳，杨振锋    宝鸡市人民医院麻醉科，陕西 宝鸡 721000

      卷次： 2023年34卷18期

      【摘要】 目的 研究七氟烷联合丙泊酚在儿童扁桃体切除术中的麻醉效果及其对苏醒质量和应激反应的影响。方法 选取2020年4月至2022年4月宝鸡市人民医院收治的90例拟行扁桃体切除术患儿为研究对象，按随机数表法分为研究组和对照组各45例。对照组患儿采用丙泊酚维持麻醉，研究组患儿采用七氟烷联合丙泊酚维持麻醉。比较两组患儿在麻醉前与拔管5 min后心率(HR)、平均动脉压(MAP)、舒张压(SBP)、收缩压(DBP)水平与应激反应[去甲肾上腺素(NE)、肾上腺素(E)、肾素(R)]水平；同时比较两组患儿拔管5 min后的苏醒质量[苏醒时间、自主呼吸恢复时间、意识恢复时间、拔管时间、苏醒期躁动(PAED)评分]与不良反应发生情况。结果 麻醉前，两组患儿的HR、MAP、SBP、DBP比较差异均无统计学意义(P>0.05)，而拔管 5 min后，两组患儿的HR、MAP、SBP、DBP均升高，且研究组患儿的 HR、MAP水平分别为 (91.06±8.62)次/min、(77.18±5.86) mmHg，明显低于对照组的(98.95±9.26)次/min、(79.84±5.72) mmHg，SBP、DBP水平分别为(68.26±9.62) mmHg、(116.25±6.58) mmHg，明显高于对照组的(63.52±9.28) mmHg、(108.49±7.24) mmHg，差异均有统计学意义(P<0.05)；麻醉前，两组患儿的NE、E、R水平比较差异均无统计学意义(P>0.05)，而拔管5 min后，两组患儿的NE、E、R水平均升高，且研究组患儿的NE、E、R水平分别为(86.36±5.84) ng/mL、(101.32±6.58) ng/mL、(4.06±0.53) ng/mL，明显低于对照组的(118.56±6.28) ng/mL、(128.62±7.04) ng/mL、(4.95±0.76) ng/mL，差异均有统计学意义(P<0.05)；两组患儿的苏醒时间、自主呼吸恢复时间、意识恢复时间、拔管时间比较差异均无统计学意义(P>0.05)；研究组患儿的PAED评分为(4.58±0.64)分，明显低于对照组的(9.64±0.59)分，差异有统计学意义(P<0.05)；研究组患儿术后不良反应发生率为 17.78%，略高于对照组的13.33%，但差异无统计学意义(P>0.05)。结论 七氟烷联合丙泊酚在儿童扁桃体切除术中的应用，能有效维持患儿术中生命体征的稳定，有助于缓解患儿的应激反应，提高苏醒质量，且安全性高，具有临床应用价值。
      【关键词】 儿童；扁桃体切除术；七氟烷；丙泊酚；诱导麻醉；苏醒质量；应激反应；不良反应
      【中图分类号】 R726.1 【文献标识码】 A 【文章编号】 1003—6350（2023）18—2678—05

Anesthesia effect of sevoflurane combined with propofol in pediatric tonsillectomy and its impact on stressresponse and recovery quality.
BI Xing, MA Ya-fang, YANG Zhen-feng. Department of Anesthesiology, Baoji People'sHospital, Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To study the anesthetic effect of sevoflurane combined with propofol in tonsillectomy ofchildren and its influence on quality of recovery and stress response. Methods From April 2020 to April 2022, 90 chil-dren with tonsillectomy who were admitted to Baoji People's Hospital were selected and randomly divided into a studygroup and a control group using a random number table method, each with 45 cases. The control group was anesthetizedwith propofol, while the study group was anesthetized with sevoflurane and propofol. The levels of heart rate (HR),mean arterial pressure (MAP), diastolic pressure (SBP), systolic pressure (DBP), and stress response [norepinephrine(NE), epinephrine (E), renin (R)] before anesthesia and 5 minutes after extubation were compared between the twogroups. The awakening quality [awakening time, spontaneous breathing recovery time, consciousness recovery time, ex-tubation time, awakening restlessness (PAED) score] and adverse reactions of two groups of children after 5 minutes ofextubation were recorded and compared. Results Before anesthesia, there was no statistically significant difference inHR, MAP, SBP, and DBP between the two groups (P>0.05); after 5 minutes of extubation, HR, MAP, SBP, and DBP inboth groups of children increased, and the levels of HR and MAP in the study group were (91.06±8.62) times/min and(77.18±5.86) mmHg, which were significantly lower than (98.95±9.26) times/min and (79.84±5.72) mmHg in the con-trol group; the levels of SBP and DBP were (68.26±9.62) mmHg and (116.25±6.58) mmHg, which were significantlyhigher than (63.52±9.28) mmHg and (108.49±7.24) mmHg in the control group; the differences were statistically signifi-cant (P<0.05). Before anesthesia, there was no statistically significant difference in the levels of NE, E, and R betweenthe two groups of children (P>0.05); after 5 minutes of exhumation, the levels of NE, E, and R in the two groups of chil-dren all increased, and the levels of NE, E, and R in the study group were (86.36±5.84) ng/mL, (101.32±6.58) ng/mL,and (4.06±0.53) ng/mL, which were significantly lower than (118.56±6.28) ng/mL, (128.62±7.04) ng/mL, and (4.95±0.76) ng/mL in the control group; the differences were statistically significant (P<0.05). There was no statistically signifi-cant difference in the recovery time, spontaneous breathing recovery time, consciousness recovery time, and extuba-tion time between the two groups of children (P>0.05). The PAED score of the study group was (4.58±0.64) points,which was significantly lower than (9.64±0.59) points in the control group (P<0.05). The incidence of postopera-tive adverse reactions in the study group was 17.78%, which was slightly higher than 13.33% in the control group(P>0.05). Conclusion The application of sevoflurane combined with propofol in pediatric tonsillectomy can effective-ly maintain the stability of vital signs during surgery, help alleviate stress reactions, improve the quality of recovery, andhave high safety, which has clinical application value.
      【Key words】 Children; Tonsillectomy; Sevoflurane; Propofol; Induced anesthesia; Awakening quality; Stress re-sponse; Adverse reactions