不同剂量瑞芬太尼复合七氟醚诱导用于小儿无肌松药气管插管的研究

Different doses of remifentanil combined with sevoflurane used to tracheal intubation in children without relaxants

目的探求瑞芬太尼复合七氟醚诱导用于小儿无肌松药气管插管的剂量-效应关系。方法45例行择期手术的全麻患儿,按不同剂量瑞芬太尼随机均分4组:R1组2.0μg/kg,R2组2.5μg/kg,R3组3.0μg/kg。诱导使用8%七氟醚半紧闭吸入,待患儿入睡后开放静脉,维持2.5%七氟醚吸入15min后分别静脉注射3个不同剂量的瑞芬太尼辅助气管插管。分别于麻醉诱导前(T0)、气管插管前即刻(T1)、插管后1min(T2)、3min(T3)记录平均动脉压(MAP)、心率(HR),并对插管条件进行评估。结果R1组气管插管条件满意率低于R2、R3组(χ2=6.71,P<0.05),但R2、R3组差异无统计学意义(χ2=0.24,P>0.05);与T0时比较,各组患儿在T1时HR、MAP均明显下降(F分别=7.56、6.35,P均<0.05),R1组在T2、T3时HR、MAP较T1明显升高(F分别=13.34、11.75,P均<0.05),且与R2、R3组比较,差异均有统计学意义(F分别=8.59、7.81,P均<0.05),但R2、R3组在T2、T3时HR、MAP与T1比较,差异均无统计学意义(F分别=3.65、4.12,P均>0.05)。结论瑞芬太尼2.5～3.0μg/kg复合2.5%七氟醚用于小儿无肌松药气管插管时,可提供满意的气管插管条件和稳定的血流动力学。

Objective To study the dose-effect of remifentanil for tracheal intubation in children anesthetized with 2.5% sevoflurane inhalation without relalants. Methods Forty-five pediatric patients were assigned into three groups with different doses of remifentanil： group Rl（remifentanil 2.0ug·kg^-1）, group R2（remifentanil 2.5ug/ kg）, group R3 （remifentanil 3.0ug/kg）.Anesthsia was induced by sevoflurane inhalation at 8vol%.When the patients lost consciousness ,maintained by 2.5% sevoflurane inhalation for 15min,anesthesia were followed by remifentanil 2.0,2.5,3.0ug/kg,respectively. MAP and HR were recorded before induction,before intubation,and at 1 and 3 min after intubation.Intubation conditions was evaluated. Results The satisfactoly degree of intubation conditions in group R1 was significantly lower compared to that in group R2 and R3 （X^2=6.71 ,P〈0.05）,but there was no siginifacant difference between group R2 and group R3 （X^2=0.24, P〉0.05）.There was a significant reduction in MAP and HR before intubation compared to those before induction in all groups （F= 7.56, 6.35,P〈0.05）.Tracheal intubation was associated with an increase in MAP and HR in group R1 （F =13.34, 11.75,P〈0.05）,and there was more increase in group R1 than that in group R2 and R3（F=8.59, 7.81 ,P〈0.05）.There was no significant difference in MAP and HR at 1 and 3 min after intubation compared to those before intubation in group R2 and R3（F = 3.65, 4.12,P〉0.05）. Conclusions 2.5-3.0ug/kg remifentanil with 2.5% sevoflurane without relaxants can provide clinically acceptable tracheal intubating conditions and stable hemodynamic.