小儿非肌松条件下七氟烷吸入复合静脉不同剂量瑞芬太尼诱导气管插管

Inductions and Intubating Conditions with Sevoflurane and Different Doses of Remifentanil without Muscle Relaxant in Children

目的观察小儿3%七氟烷联合不同剂量瑞芬太尼诱导气管插管的临床效果。方法120例4～10岁、美国麻醉医师协会分级I级、行吸入麻醉诱导的择期整形外科手术的小儿,随机分为瑞芬太尼1μg/kg(Ⅰ)组、2μg/kg(Ⅱ)组、3μg/kg(Ⅲ)组和对照组。4组入室后均吸入3%七氟烷、60%氧化亚氮和40%氧气,2min后Ⅰ、Ⅱ和Ⅲ组分别于1min内静脉注射瑞芬太尼1μg/kg、2μg/kg和3μg/kg,辅助通气1min后气管插管;对照组静脉注射维库溴铵0.1mg/kg,2min后气管插管。观察诱导插管过程中躁动发生率、插管满意率及插管对循环功能的影响等。结果诱导过程中躁动发生率平均为37.5%。Ⅰ、Ⅱ、Ⅲ和对照组插管满意率分别为70.0%、86.7%、90.0%和93.3%。与对照组相比,Ⅰ、Ⅱ和Ⅲ组插管对循环功能的影响较小。结论吸入3%七氟烷联合瑞芬太尼诱导过程平稳,能顺利完成气管插管,其中复合2μg/kg和3μg/kg瑞芬太尼插管条件更满意。

Objective To observe the clinical effectiveness of inductions and tracheal intubating conditions with 3 % sevoflurane and different doses of remifentanil without muscle relaxant in children. Methods Totally 120 peadiatric patients （aged 4-10 years, American Society of Anesthesiologists grade Ⅰ for inhalational induction） were randomly allocated into group Ⅰ（remifentanil 1 μg/kg）, group Ⅱ （remifentanil 2 μg/kg）, group Ⅲ （remifentanil 3 μg/kg） , and control group （vecuronium bromide 0. 1 mg/kg）. After inhalational induction with 3% sevoflurane and 60% nitrous oxide in 40% oxygen for 2 minutes, remifentanil 1 μg/kg, 2 μg/ kg, and 3 μg/kg were intravenously injected over 1 minute into patients in group Ⅰ , group Ⅱ , and group Ⅲ, respectively. After remifentanil administration and manual ventilation for 1 minute, the trachea was intubated. In the control group, 2 minutes after intravenous administration of vecuronium bromide 0. 1 mg/kg, tracheal intubation was attempted. Agitation, intubating satisfactoriness, and the circulation changes after tracheal intubation and anesthesia induction were observed. Results In these four during sevoflurane induction. Satisfactory intubation rate was 70. groups, agitation occurred in 37. 5% of patients 0% in group Ⅰ , 86. 7% in group 11,90. 0% in group Ⅲ, and 93.3 % in the control group. Compared with the control group, the impact of tracheal intubation on the circulatory system was smaller in group Ⅰ ,Ⅱ , and Ⅲ. Conclusions Induction with 3% sevoflurane combined with remifentanil can be smoothly performed, followed by the successful tracheal intubation. The intubating conditions are more satisfactory with 3% sevoflurane combined with remifentanil 2 μg,/kg or 3 μg/kg.