摘要
目的 分析七氟烷-咪达唑仑-瑞芬太尼麻醉诱导用于短小手术患儿无肌松药气管插管的效果.方法 40例择期手术全麻患儿,美国麻醉师协会（American Society of Anesthesiologists,ASA）评分Ⅰ～Ⅱ级.麻醉诱导：静脉注射咪达唑仑0.03 mg/kg,面罩吸入6％七氟烷,每15 s递减0.5％,直至3％,待患儿睫毛反射消失时,1 min内缓慢静脉注射瑞芬太尼2μg/kg,30 s后停止吸入七氟烷,气管插管后行机械通气.于麻醉诱导前、气管插管后即刻和插管后3 min,记录平均动脉压（meanartery pressure,MAP）、心率（heart rate,HR）、脉搏血氧饱和度（pulse oxygen saturation,SpO2）和脑电双频指数（bispectral index,BIS）,记录患者睫毛反射消失时间,评价气管插管条件.结果 所有患儿睫毛反射消失时间为（58±10）s,气管插管条件优良率94％.与麻醉诱导前比较,气管插管后3 min MAP降低（P=0.045）,气管插管后即刻、气管插管后3 min HR（P=0.038,P =0.030）,BIS（P=0.012,P=0.009）明显降低.结论 七氟烷-咪达唑仑-瑞芬太尼麻醉诱导迅速而平稳,可提供良好的气管插管条件,对于短小手术患儿无肌松药气管插管,安全可行。
Objective To analyze the effect of anesthesia induction with sevoflurane-midazolam-remifentanil for tracheal intu- bation without muscle relaxants in children with short operation. Methods Forty children patients, American Society of Anesthesiolo- gists（ASA） score Ⅰ or Ⅱ, scheduled for surgery under general anesthesia. Anesthesia was induced with intravenous injection of mid- azolam 0. 03 mg/kg . Sevoflurane was inhaled through a mask at the initial concentration of 6% ,followed by decrement of 0.5% every 15 seconds until 3%. When the eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly through veins in 1 minute and 30 seconds later sevoflurane inhalation was stopped. The children patients were mechanically ventilated after tracheal intubation. The values of mean artery pressure（MAP） , heart rate（HR） , pluse oxygen saturation（ SpO_2 ） , and bispectral index（BIS） at the time of before an- esthesia induction, tracheal intubation immediately and 3 minutes after intubation were recorded. The time of disappearance of eyelash reflex was recorded. The intubation condition was evaluated. Results The time period from sevoflurane inhalation to disappearance of eyslash reflex of all children patients was （58±10） seconds. The satisfactory rate of tracheal intubation conditions was 94%. Com- pared with the time of before anesthesia induction, the value of MAP decreased （ P = 0.045 ） at the time of 3 minutes after intubation, the value of HR （P = 0. 038 ,P = 0. 030）, BIS （P = 0. 012, P = 0. 009 ） were significantly reduced at the time of tracheal intubation immediately and 3 minutes after intubation. Conclusions Anesthesia induction with sevoflurane-midazolam-remifentanil was rapid and smooth, could provide good conditions for tracheal intubation, which was safe and feasible for tracheal intubation without masele relax- ants in children with short operation.
出处
《中华灾害救援医学》
2014年第10期553-555,共3页
Chinese Journal of Disaster Medicine
关键词
七氟烷
咪达唑仑
瑞芬太尼
气管插管
小儿短小手术
sevoflurane
midazolam
remifentanil
tracheal intubation
children with short operation
