无肌松药条件下丙泊酚联合不同剂量雷米芬太尼用于小儿气管插管

Clinical condition for tracheal intubation without muscle relaxant in children after anesthesia induction with propofol and different doses of remifentanil

目的观察无肌松药条件下丙泊酚联合不同剂量雷米芬太尼静脉诱导用于患儿气管插管的临床效果。方法 90例4～10岁 ASA Ⅰ级行择期整形外科手术的患儿随机均分为三组。三组在60 s 内静脉分别注射雷米芬太尼1 μg/kg(Ⅰ组)、2μg/kg(Ⅱ组)和3 μg/kg(Ⅲ组),丙泊酚4 mg/kg 在20 s 内静脉注射,40 s 后实施气管插管。根据下颌松弛度、声带位置、置入喉镜难易度、咳嗽程度和体动程度将插管条件分为满意、一般和差。结果三组均能完成气管插管。Ⅰ组、Ⅱ组和Ⅲ组插管条件满意率分别为46.7%、86.7%和90.0%。与Ⅰ组相比,Ⅱ、Ⅲ组插管满意率明显增高(P<0.05),插管时间明显缩短(P<0.01),Ⅲ组 HR 明显减慢(P<0.05)。结论在无肌松药条件下,丙泊酚4 mg/kg 联合雷米芬太尼2或3μg/kg 均可为小儿气管插管提供较好的插管条件。

Objective To observe the clinical condition for tracheal intubation without muscle relaxant in children after anesthesia induction with propofol and different doses of remifentanil. Methods Ninety aged 4-10 years old ASA class Ⅰ peadiatric patients scheduled for elective plastic surgery were randomized to 3 groups. Anesthesia was induced by intravenous injection of remifentanil 1μg/kg（group Ⅰ ）, 2 μg/kg（group Ⅱ ） or 3 μg/kg（group Ⅲ ） over 60 s, respectively, after which propofol 4 mg/kg was given over 20 s. Tracheal intubation was attempted at 40 s after propofol administration. Intuhating conditions were graded as satisfactory, average and poor based on the five factors of jaw relaxation, ease of laryngoscope, vocal cord position, coughing, and patient movement. Results Tracheal intubation were performed successfully in all three groups. The satisfactory rates were 46.7% ,86.7% and 90% in group Ⅰ , Ⅱ and Ⅲ ,respectively. Compared with group Ⅰ ,intuhating conditions were better greatly in group Ⅱ and Ⅲ, hut HR was decreased significantly in group Ⅲ. Conclusion Without muscle relaxant, a better tracheal intubation could be proved by propofol 4 mg/kg and remifentanil 2 μg/kg or 3μg/kg in children.