全凭七氟烷吸入及七氟烷复合丙泊酚麻醉诱导用于小儿无肌松气管插管的临床效果

Induction efficay of sevoflurane and sevoflurane combined with propofol for tracheal intubation without muscle relaxants

目的评价全凭七氟烷吸入和七氟烷复合不同剂量丙泊酚麻醉诱导进行小儿无肌松气管插管的临床效果。方法选择60例行择期手术的患儿,年龄1～10岁,平均年龄为(4.2±1.2)岁,体重9～30kg,平均体重为(12.9±3.1)kg美国麻醉医师学会分级Ⅰ～Ⅱ级。将患儿随机均分为全凭七氟烷吸入诱导组(A组)、七氟烷复合2mg/kg丙泊酚组(B组)和七氟烷复合3mg/kg丙泊酚组(C组)。患儿入手术室后,调节挥发罐刻度至6%,氧流量为5L/min,预充呼吸环路30s后,予面罩吸入七氟烷。待睫毛反射消失,下颌松弛后,A组继续予七氟烷吸入诱导100s后行气管插管;B、C两组先分别静脉注射丙泊酚2、3mg/kg,再继续予七氟烷吸入100s后行气管插管。记录麻醉诱导前、插管前即刻及插管后1、3、5min时患儿的平均动脉压(MAP)和心率(HR),以及插管时的反应。结果所有患儿均一次性顺利完成插管,仅A组有4例患儿发生呛咳及有体动反应。A组气管插管条件满意率为45%(9/20),显著低于B组的70%(14/20)和C组的80%(16/20,P值均<0.05)。C组气管插管前即刻的MAP为(75±10)mmHg(1mmHg=0.133kPa),显著低于同组诱导前的(92±11)mmHg(P<0.05)。A组插管后1min的MAP为(104±16)mmHg、HR为(126±14)次/min,显著高于同组诱导前的(89±9)mmHg、(106±10)次/min及同组插管前即刻的(80±10)mmHg和(100±14)次/min(P值均<0.05)。结论七氟烷复合不同剂量(2～3mg/kg)丙泊酚进行麻醉诱导的过程平稳,可抑制插管反应,为气管插管提供较好的条件。

Objective To evaluate the efficacy of anesthesia induction with sevoflurane and sevoflurane combined with propofol for tracheal intubation without muscle relaxants in children.Methods Sixty ASA Ⅰor Ⅱ patients,aged 1-10 year,weighing 10-40 kg,and who were scheduled for elective surgery under general anesthesia,were enrolled in this study.The patients were randomized into 3 groups （n=20 each）：sevoflurane group （group A）,sevoflurane combined with 2 mg/kg propofol group （group B）,and sevoflurane combined with 3 mg/kg propofol group （group C）.Sevoflurane was inhaled initially with high-flow oxygen （5 L/min）.Sevoflurane anesthetic vaporizer dial was set of 6%.When the patients’ eyelash reflex disappeared and the submaxilla was loosed,group A continued inhalation of sevoflurane for 100 second with controlled ventilation;group B continued inhalation of sevoflurane and received 2 mg/kg propofol;group C continued inhalation of sevoflurane and received 3 mg/kg propofol.The mean arterial pressure （MAP） and heart rate were recorded before administration,before tracheal intubation,and 1 min,1 min,and 5 min after tracheal intubation.Patients’ response to tracheal intubation was also recorded.Results All patients were successfully intubated at the first attempt.Only 4 children in group A had cough and body movement.The intubation satisfactory rate of group C was 80%,which was significantly higher than those of group A（45%） and group B（70%） （P0.05）.The MAP before intubation was （75±10） mmHg（1 mmHg=0.133 kPa） in group C,which was significantly lower than that before induction （[92±11] mmHg,P0.05）.The MAP in group A was （104±16） mmHg and the heart rate was （126±14）/min 1 min after intubation,both significantly higher than those before induction （[89±9] mmHg,[106±10]/min） and those immediately before intubation（[80±10] mmHg,[100±14]/min,P0.05）.Conclusion Induction with sevoflurane and propofol （2-3 mg/kg）is smooth and can effectively inhibit response to tracheal intubation in childern without muscle relaxants.（Shanghai Med J,2010,33：332-334）