雷米芬太尼在小儿麻醉中的临床应用近况

Application of remifentanil in pediatric anesthesia

雷米芬太尼（remifentanil）是目前最新的短效斗一阿片样受体激动剂，其药代动力学参数小儿与成人相似。可用在小儿静吸复合麻醉及全凭静脉麻醉的诱导及维持中，包括心脏及非心脏手术，控制性降压、门诊手术麻醉。但不适合小儿清醒镇静中使用。雷米芬太尼的镇痛和呼吸抑制作用呈剂量依赖型，且镇痛作用有最大效应限制。临床应用须结合小儿的生理特点，个体化用药。

Remifentanil is a newest ultrashort-acting, selective m-opioid receptor agonist up to now. Its pharmacokinetic profile in neonates and children is similar to that in adults. Remifentanil is applicable for anesthesia induction and maintenance during balanced general anesthesia and total intravenous anesthesia （TIVA） in pediatric patients undergoing cardiac/non-cardiac surgery, controlled hypotension and outpatient surgery. However, it is generally unsuitable for sedation in conscious children. Remifentanil induces analgesia as well as respiratory depression in a dose-dependent manner, and the analgesic effect exhibits as ceiling style. It should be applied individually basing on the physiologic characteristics of children in clinical practice.