依托咪酯复合舒芬太尼用于小儿喉罩放置的临床观察

Clinical observation of etomidate combined with sufentanil for laryngeal mask airway insertion in children

目的探讨依托咪酯复合舒芬太尼用于小儿喉罩放置的麻醉效果。方法选择小儿患者60例,随机均分为依托咪酯组(E组,n=30)和丙泊酚组(P组,n=30)。麻醉诱导时,两组患者先缓慢注入舒芬太尼0.3μg/kg,随后E组注入依托咪酯乳剂0.3 mg/kg,P组注入丙泊酚2 mg/kg,采用反转法放置喉罩。观察患儿喉罩置入时反应,出现吞咽、呛咳、屏气、喉痉挛等气道反应或肢体运动,均认为喉罩置入体动反应阳性;记录麻醉诱导前、后1 min和喉罩置入后1 min患者的HR、SBP、DBP;记录每例患者成功放置喉罩的置入次数及肌阵挛等不良反应发生的病例数。结果喉罩置入体动反应阳性例数:E组2例(6.7%),P组1例(3.3%),两组差异无统计学意义(P>0.05)。E组喉罩放置首次成功28例(93.3%),两次放置成功2例(6.7%),P组喉罩放置首次成功27例(90.0%),两次放置成功3例(10.0%),两组差异无统计学意义(P>0.05)。两组麻醉诱导后1 min和喉罩置入后1 min患者SBP、DBP与麻醉诱导前比较,E组略有下降(P>0.05),P组明显降低(P<0.01),两组麻醉诱导后1 min和喉罩置入后1 min相同时点比较,E组患者SBP、DBP明显高于P组(P<0.01)。两组均未发生肌阵挛。结论依托咪酯复合0.3μg/kg舒芬太尼用于小儿全身麻醉诱导,血流动力学稳定,能提供良好的喉罩放置条件。

Objective To explore the effect and safety of etomidate combined with sufentanil for laryngeal mask airway （LMA） insertion in children. Methods 60 children undergoing operation were randomly divided into etomidate group （group E,n=30） and propofol group （group P,n=30）.During induction sufentanil （0.3μg/kg） was injected slowly first,then 0.3 mg/kg etomidate or 2 mg/kg propofol was injected respectively in two groups.LMA was inserted by inversion method.All reactions such as swallowing,coughing,breath holding,laryngospasm and limb movements were defined as positive body reaction.The HR,SBP and DBP were recorded at 1 min before or after induction and after LMA insertion. Times for successful LMA insertion and the adverse reactions such as the number of cases of myoclonus were observed in all children. Results There was no significant difference for LMA insertion body reaction between group E （2 cases, 6.7%） and group P （1 case,3.3%） （P〉0.05）.In group E,28 patients （93.3%） were successfully inserted LMA in the first time,while 2 patients （6.7%）did in the second time.In group P,27 patients （90.0%） were successfully inserted LMA in the first time and 3 patients （10.0%）did in the second time.There was no significant difference for rate of success be- tween two groups （P〉0.05）.SBP and DBP decreased slightly at 1 min after anesthesia induction and 1 min after LMA insertion in group E （P〉0.05）,while group P decreased significantly （P〈0.01）.At 1 min after induction and 1 min after LMA insertion,SBP and DBP in group E were significantly higher than those in group P （P〈0.01）.There was no my- oclonus in two groups. Conclusion Etomidate combined with sufentanil （0.3 μg/kg） can provide a good condition for LMA insertion with stable hemodynamics during induction.