芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学

Pharmacodynamics of fentanyl for inhibition of emergence agitation aftar sevoflurane-remifentanil anesthesia in children

目的 探讨芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的药效学.方法 择期拟行鼻内镜下增殖体刮除术的息儿26例,年龄5～8岁,体重15～30 kg,ASA Ⅰ或Ⅱ级.麻醉诱导：吸入8%七氟醚（氧流量6 L/min）,静脉注射瑞芬太尼1 μg/kg（经30 s注射完）,气管插管后行机械通气,随后静脉注射芬太尼抑制麻醉恢复期间患儿躁动,采用改良的序贯法确定静脉注射芬太尼的剂量.第1例患儿静脉注射芬太尼的剂量为4μg/kg,相邻剂量差值为0.5μg/kg,以患儿苏醒后易激惹且难以安慰作为判断躁动发生的标准.麻醉维持：吸人2%七氟醚（氧流量1 L/min）,静脉输注瑞芬太尼0.2μg·kg^-1·min^-1.术毕停用七氟醚和瑞芬太尼,带气管导管回麻醉恢复室,待患儿苏醒.记录术后4h内患儿躁动、恶心、呕吐、呼吸抑制等的发生情况及苏醒时间.计算芬太尼抑制50%、95%患儿七氟醚复合瑞芬太尼麻醉恢复期间躁动的剂量（ED50、ED95）及其95%可信区间.结果 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50及其95%可信区间为3.01（2.52～3.40）μg/kg,En95及其95%可信区间为3.81（3.41～6.22）μg/kg.术后4h内未发生明显恶心、呕吐及呼吸抑制.苏醒时间（11.3±2.6）min.结论 芬太尼抑制七氟醚复合瑞芬太尼麻醉恢复期间患儿躁动的ED50为3.01μg/kg,ED95为3.81μg/kg.

Oblective To define the median effective dose （ED50） and 95%effective dose of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanil anesthesia in children.Methods Twenty six ASA ⅠorⅡchildren aged 5-8 yr weighing 15-30 kg undergoing adenoidectomy under general anesthesia were studied.The patients were unpremedicated.Anesthesia was induced with inhalation of 8%sevoflurane （fresh gas flow=6 L/min）and iv remifentanil 1μg/kg.The patients were mechanically ventilated after tracheal intubation.Fentanyl was injected iv to inhibit emergence agitation.The dose of fentanyl was determined by using modified Dixon＇s upand-down method （increment or decrement of 0.5μg/kg）.The initial dose of fentanyl was 4 μg/kg.Anesthesia Sevoflurane inhalation and remifentanil infusion were terminated at the end of operation.The patients were transferred to the PACU.No alteration in the ventilatory settings was made.Stimulation of the patients was avoided during emergence.The emergence time and the occurrence of agitation,nausea and vomiting and respiratory depression within 4h after operation were recorded.ED50,ED95 and 95%confidence interval （CI） of fentanyl for inhibition of emergence agitation were calculated.Results ED50 was 3.01μg/kg （95%CI 2.52-3.40μg/kg） and ED95 3.81μg/kg（95%CI 3.41-6.22μg/kg）.No nsusea and vomiting and respiratory depression occurred within 4h after operation.The emergence time was （11.3±2.6） min.Conclusion The ED50 and ED95 of fentanyl for inhibition of emergence agitation after sevoflurane-remifentanyl anesthesia were 3.01 and 3.81μg/kg respectively in children.