靶控输注瑞芬太尼复合七氟醚诱导用于小儿气管插管

Different plasma concentrations of remifentanil combined with sevoflurane used to tracheal intubation in pediatric patients

目的观察不同血浆浓度瑞芬太尼复合七氟醚诱导,对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60例择期气管插管全麻患儿,按不同血浆浓度瑞芬太尼随机分为3组,Ⅰ组2 ng/ml,Ⅱ组3 ng/ml,Ⅲ组4 ng/ml。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5 min后开始分别静脉靶控输注3个不同血浆浓度的瑞芬太尼,10 min后气管插管。分别于麻醉诱导前(T0)、气管插管前即刻(T1)、插管后1 min(T2)、3 min(T3)记录平均动脉压(MAP)、心率(HR),并对插管条件进行评估。结果Ⅰ组气管插管条件满意率低于Ⅱ、Ⅲ组(P<0.05),但Ⅱ、Ⅲ组差异无统计学意义(P>0.05);与T0时比较,各组患儿在T1时HR、MAP均明显下降(P<0.05),Ⅲ组下降幅度最大(P<0.01);Ⅰ组在T2、T3时HR、MAP较T1明显升高(P<0.05),且与Ⅱ、Ⅲ组比较,差异均有统计学意义(P<0.05),但Ⅱ、Ⅲ组在T2、T3时HR、MAP与T1比较,差异均无统计学意义(P>0.05)。结论瑞芬太尼3 ng/ml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 observe the tracheal intubation conditions and hemodynamic changes during remifentanil target controlled infusion （TCI）at different plasma concentrations combined with 2. 5% sevoflurane. Methods Sixty pediatric patients were randomly allocated into three groups,remifentanil were given using TCI at plasma concentration of 2 ng/ml（ groupl ） ,3 ng/ml（ group 2） ,4 ng/ml（ group3 ） in each group respectively. Anesthsia was induced by sevoflurane inhalation at 8% , when the patients lost consciousness, maintained by 2. 5% sevoflurane inhalation for 5 rains, anesthesia were followed by remifentanil TCI. MAP and HR were recorded before induction, before intubation, and at 1 and 3 min after intubation, intubation conditions were evaluated. Results The satisfactory degree of intubation conditions in group 1 was significantly lower compared to that in group 2 and 3, but there was no significantly different between group 2 and 3. There was a significant reduction in MAP and HR before intubation compared to those before induction in all groups. Tracheal intubation was associated with an increase in group 1 than that in group 2 and 3. There was no significant difference in MAP and HR at 1 and 3 rain after intubation in group 2 and 3. Conclusion Remifentanil TCI with 3 ng/ml combined with 2. 5% sevoflurane without relaxants can provided clinically acceptable tracheal intubation conditions and stable hemodynamic.