联合靶控输注丙泊酚和瑞芬太尼诱导儿童无肌松气管插管

Induction of Tracheal Intubation without Muscle Relaxant by Target-controlled Infusion of Propofol Combined with Remifentanil in Children

目的探讨丙泊酚和瑞芬太尼联合靶控输注用于儿童无肌松气管插管的有效性和安全性。方法将100例4～10岁、ASAⅠ级行择期整形外科手术的儿童按照计算机随机分组的方法分为瑞芬太尼组和对照组,每组50例。静脉注射0.01 mg/kg阿托品和0.1 mg/kg咪达唑仑5 min后,靶控输注丙泊酚,丙泊酚的效应室浓度为6μg/ml。待效应室药物浓度达到平衡后,给瑞芬太尼组患儿靶控输注瑞芬太尼的同时静脉注射生理盐水0.1 ml/kg,瑞芬太尼的效应室浓度为5 ng/ml;给对照组患儿靶控输注生理盐水的同时静脉注射罗库溴铵0.8 mg/kg。待瑞芬太尼效应室浓度达到平衡后行气管插管。根据下颌松弛度、置入喉镜容易度、声带位置、咳嗽程度及体动5个方面进行气管插管条件评分。结果瑞芬太尼组和对照组的插管成功率分别为90%和98%。两组气管插管条件评分的差异无统计学意义(P=0.122)。结论联合靶控输注效应室浓度6μg/ml的丙泊酚和效应室浓度5 ng/ml的瑞芬太尼能成功诱导儿童无肌松气管插管。

Objective To observe the safety and feasibility of tracheal intubation by target-controlled infusion of propofol and remifentanil without muscle relaxant in children.Methods Totally 100 4-10-year-old pediatric patients（ASAⅠ） who had been scheduled for plastic surgery were equally divided into remifentanil group and control group through computer-generated randomized grouping.In all patients,five minutes after intravenous administration of atropine 0.01 mg/kg and midazolam 0.1 mg/kg,propofol was infused at the targeted effect-site concentration（Ce）of 6 μg/ml.When the intended target Ce of propofol was reached,the remifentanil group began to be infused with remifentanil at a Ce of 5 ng/ml,and normal saline（0.1 ml/kg） was injected simultaneously.In the control group,remifentanil was replaced by normal saline,and rocuronium（0.8 mg/kg） was injected together with the normal saline.After the equilibration of plasma and the Ce of remifentanil were reached,tracheal intubation was attempted.The complications during the induction and tracheal intubation were recorded.The intubating conditions were assessed using a five-point scoring system based on ease of laryngoscopy,vocal cords position,coughing,jaw relaxation and limb movement.Results The success rate of tracheal intubation was in 90% in remifentanil group and 98% in the control group（P=0.122）.Conclusion Target-controlled infusion of propofol and remifentanil at Ce of 6 μg/ml and 5 ng/ml is feasible for the induction and tracheal intubation without muscle relaxant in children.