摘要
目的评价在不使用肌松药情况下不同剂量瑞芬太尼复合舒芬太尼减轻脑瘫小儿经口气管插管心血管反应的效果。方法 60例行择期手术脑瘫患儿,随机均分为3组,瑞芬太尼用量分别为2μg/kg组(R1组),4μg/kg组(R2组),6μg/kg组(R3组)。诱导给予丙泊酚(3 mg/kg)和舒芬太尼(0.3μg/kg)后分别静脉输注3个不同剂量的瑞芬太尼行气管插管,分别于麻醉诱导前,气管插管前即刻,插管后1 min、3 min记录平均动脉压和心率,并对插管条件进行评估。结果诱导后各组心率、血压均有下降,以R2和R3组尤其明显,平均动脉压显著下降则见于R3组;R1组患儿插管后与插管前即刻相比心率与血压明显升高。R1组气管插管条件满意率低于R2、R3组(70%vs.95%、100%,P<0.05),但R2、R3组间差异无统计学意义(P>0.05)。结论瑞芬太尼4μg/kg复合丙泊酚、舒芬太尼用于脑瘫小儿无肌松药直接喉镜经口气管插管时,麻醉诱导平稳、安全,可提供满意的气管插管条件。
Objective To assess the efficacy of different dosages of remifentanil combined with propofol and sufen-tanil attenuating the cardiovascular response to tracheal intubation in children anesthetized without relaxants, in order to determine the optmial dose of remifentanil for this purpose. Methods Sixty cerebral palsy pediatric patients were assigned into three groups with different doses of remifentanil： group R1（remifentanil 2μg/kg）, group R2（remifentanil 4μg/kg）, and group R3（remifentanil 6μg/kg）. After anesthesia induction with propofol （3 mg/kg） and sufentanil （0.3μg/kg）, pumping dif-ferent doses of remifentanil to tracheal intubation. MAP and HR were recorded before induction, before intubation, and at 1 and 3 min after intubation. Intubation conditions were evaluated. Results There was a significant reduction in HR after induction in all groups, especially in group R2 and R3. A significant reduction in MAP after induction in group R3. Tra-cheal intubation was associated with an increase in MAP and HR in Group R1（P〈0.05）.The satisfactory degree of intuba-tion conditions in group R1 was significantly lower compared to those in group R2 and R3（70%vs. 95%、100%, P〈0.05）, but there was no significant difference between group R2 and R3 （P〉0.05）. Conclusion Remifentanil 4μg/kg combined with propofol and sufentanil without relaxants can provide clinically acceptable tracheal intuhation conditions and stable hemodynamics.
出处
《北京医学》
CAS
2014年第8期656-658,共3页
Beijing Medical Journal
关键词
儿童
脑瘫手术
麻醉诱导
丙泊酚
瑞芬太尼
无肌松
气管插管
Children
Cerebral palsy operation
Anesthesia induction
Propofol
Remifentanil
With-out muscle relaxants
Tracheal intubation
