不同剂量瑞芬太尼用于婴幼儿麻醉的效果比较

The comparation of anesthesia with different doses of remifentanil in infants

目的 探讨静脉持续输注不同剂量瑞芬太尼对婴幼儿麻醉效果和拔管时间的影响.方法 选择ASA Ⅰ~Ⅱ级,择期行气管插管全身麻醉的0~3个月婴幼儿45例,分为三组,每组15例.静脉诱导插管后,三组患儿持续吸入2.5% ～ 3.0%七氟烷,同时分别泵入不同剂量的瑞芬太尼,A组0.15 μg·kg-1·min-1;B组0.25 μg·kg-1·min-1;C组0.33 μg·kg-1·min-1.记录诱导前（T1）、诱导后（T2）、手术开始时（T3）、术程30 min（T4）、拔管前（T5）各时点的血流动力学变化和拔管时间（T）.结果 三组患儿T2、T3、T4时,其HR和MAP较T1明显下降（P＜0.05）,T5时仅C组MAP较T1明显下降（P＜0.05）;C组的HR在T3、T4、T5明显低于A、B组（P＜0.05）,而B组仅在T4低于A组（P＜0.05）,C组MAP在T5低于A、B组（P＜0.05）;C组拔管时间较A、B组延长（P＜0.05）;A组需追加麻醉药的情况多于B和C组（P＜0.05）.结论 0.25 μg·kg-1·min-1的瑞芬太尼联合七氟烷用于0~3个月的婴幼儿术中维持麻醉,其血流动力学稳定,苏醒迅速.

Objetive To investigate the effect and the extubation time of infusion with different doses of remifentanil for infants. Methods Forty-five ASA I - II infants of 0 - 3 months underwent selective tracheal general anesthesia were divided into3 groups with 15 patients each. Three groups were inhaled with 2.5% - 3.0% sevoflurane and given different doses of remifentanil after intubation, group A with 0. 15 μg · kg^-1 · min^ -1 . mln ; groupB with0.25 μg · kg^-1 · min^ -1; group C with0.33 μg · kg^-1 · min^ -1 The hemodynamics were recorded at the time of before induction（ T1 ）, after induction（ T2 ）, skin incision（ T3 ）, 30 rain of surgery （ T4 ） and before extubation（ T5 ）, as well as the extubation time. Results The HR and MAP in all groups de- creased significantly at T2, T3, T4 compared with T1 （ P 〈 0. 05 ）, the MAP of group C decreased at T5 com- pared with T1 （ P 〈 0. 05） ; the HR of group C decreased significantly atT3, T4, T5 compared with group A and B （ P 〈 0.05 ）, and group B was lower than A just at T4 （ P 〈 0. 05）, the MAP of group C was lower than A and B at T5 （ P 〈 0. 05 ） ; the extubation time of group C was longer than A and B （P 〈 0. 05） ; the condition of adding anesthetic of group A was more than B and C （P 〈 0. 05 ）. Conclusions 0.25 μg · kg^-1 · min^ -1 of remifen- tanil combine with sevoflurane used in 0 - 3 months infants that show stable hemedynam/cs and rapid recovery.