靶控输注瑞芬太尼在小儿非肌松药气管插管中的应用

Application of Remifentanil by TCI without relaxant for tracheal intubation in pediatric patients

目的观察不同血浆浓度的瑞芬太尼复合丙泊酚时,在小儿不使用肌松药所提供的气管插管条件和心血管反应。方法45例择期手术患儿,随机分为3组,血浆浓度分别为Ⅰ组2ng/mL,Ⅱ组为3ng/mL,Ⅲ组为4ng/mL。靶控输注瑞芬太尼5min后,开始靶控输注丙泊酚(2.5μg/mL),10min后进行气管插管,失败后则增加瑞芬太尼靶控浓度1ng/mL,10min后重复,再次失败则退出本研究。在瑞芬太尼输注前,丙泊酚开始输注时置入喉镜前以及插管后1min,分别记录气管插管评分、平均动脉压和心率,同时记录不良反应和血管活性药物的使用。结果第1次插管评分,2ng/mL组、3ng/mL组及4ng/mL组分别为(9.5±2.3)、(7.1±2.4)和(5.6±1.1)分;第1次插管成功率分别为9/15(60%)、11/15(73%)和(13/15)87%;第2次插管成功率分别为3/6(50%)、3/4(75%)和2/2(100%)。各组心率均有下降,以3ng/mL和4ng/mL组尤其明显;动脉压显著下降则见于4ng/mL组。2ng/mL组患儿插管后较插管前相比心率与血压明显升高。高浓度瑞芬太尼组需用血管活性药物比例增加。结论小儿固定丙泊酚TCI血浆浓度2.5μg/mL,不使用肌松药时,瑞芬太尼3、4ng/mL血浆浓度可基本满足插管条件。随瑞芬太尼TCI浓度增加,插管成功率提高,但同时心率减慢发生率也明显上升。

[Objective] To observe the tracheal intubation conditions hemodynamic changes during Remifentanil target controlled infusion（TCI） at different plasma concentrations combined with Propofol. [Methods] Forty-five pediatric patients were randomly allocated into three groups. Remlfentanil were given using TCI at plasma concentration of 2 ng/mL, 3 ng/mL and 4 ng/mL in each group respectively and after 5-min Remifentanil infusion, Propofol was given with TCI at plasma concentration 2.5 μg/mL. Ten minutes later, inserting laryngoscope and tracheal intubation were teied and intubation conditions were recorded. If failed, the Remifentanil concentration was tried ten minutes later. The heart rate and blood pressure at baseline, after Remifentanil infusion, before intubation and one minute after intubation were recorded.Meanwhile, the intubation scores and side effects during induction were recorded.