靶控输注依托咪脂在小儿麻醉诱导中的临床观察

目的 观察靶控输注依托咪脂在小儿麻醉诱导中的临床应用广泛效果.方法 选择在我院行耳鼻喉科手术的患儿60 例作为研究对象,将其随机分为A 组和B 组,每组30 例.其中A 组患儿靶控输注丙泊酚,效应室浓度为3mg/l;B 组患儿靶控输注依托咪酯,效应室浓度为0.4mg/l,手术前5min 结束使用丙泊酚和依托咪酯.记录两组患儿麻醉前、诱导后1min、诱导后2min、插管时、插管后1min、插管后3min、切皮时患儿的收缩压、舒张压、心率变化情况;记录两组患儿的麻醉时间、手术时间、清醒时间、拔管时间;两组患儿麻醉前、拔管后和手术后第1d 清晨分别抽取2ml 静脉血,测量皮质酮、血糖、醛固酮、促肾上腺皮质激素水平;比较两组患儿手术后恶心、呕吐等不良反应发生情况.结果 与气管插管前相比,A 组患儿诱导后1min、诱导后2min 的收缩压和舒张压显著降低（P〈0.05）;A 组患儿诱导后1min、诱导后2min 的收缩压和舒张压显著低于B 组患儿（P〈0.05）;气管插管后1min 两组患儿的收缩压、舒张压和心率恢复至气管插管前的水平;两组患儿围手术期血糖值正常;插管后两组患儿皮质酮均显著升高（P〈0.05）,其中A 组患儿升高更为显著（P〈0.05）,手术后1d 两组恢复至正常水平;B 组患儿手术后促肾上腺皮质激素浓度显著高于手术前（P〈0.05）,手术后1d 恢复至正常水平;A 组患儿围手术期促肾上腺皮质激素浓度无明显变化;两组患儿的麻醉时间、手术时间、清醒时间、拔管时间、不良反应发生率无显著性差异（P〉0.05）.结论 把控输注依托咪酯对于小儿血流动力学影响小,起效迅速、苏醒快,能够有效抑制围手术期患儿出现的各种应激反应,安全有效,值得临床推广使用.

Objective To observe the clinical effect of target controlled infusion of midazolam in pediatric anesthesia induction. Methods 60cases of pediatric patients in our hospital were selected as the study subjects. They were randomly divided into A group and B group, 30 cases in eachgroup. Among a group of children with target controlled infusion of propofol injection, the effect compartment concentration is 3mg / L; group B withtarget controlled infusion of etomidate and effect compartment concentration 0.4mg/l. Before surgery 5min over the use of propofol and etomidate. Oftwo groups of patients were recorded before anesthesia, after induction of 1min, induced after 2min, intubation, intubation after 1min, after intubation3min, skin incision with contraction pressure, diastolic blood pressure, heart rate changes; records of the two groups of children anesthesia time, operationtime, recovery time and pull tube time; after surgery and two groups of patients before anesthesia, after extubation on the 1st morning were collected 2mlvenous blood, measured corticosterone, blood glucose, aldosterone, promoting adrenal cortical hormone levels; after operation were compared with twoother adverse reactions such as nausea and vomiting. Results compared with before tracheal intubation after induction of 2min, 1min, A groups wereinduced systolic blood pressure and diastolic blood pressure decreased significantly （P 〈 0.05）; 1min, after induction of 2min in A group after induction ofsystolic and diastolic blood pressure was significantly lower than that in B group （P 〈 0.05）; two 1min after tracheal intubation groups of children withsystolic pressure, diastolic pressure and heart rate returned to the level before tracheal intubation; two patients in perioperative period of normal bloodglucose levels after intubation; corticosterone two groups were significantly increased （P 〈 0.05）, which in A group were higher （P 〈 0.05）, 1D groupreturned to two after surgery normal; group B patients postoperative ACTH concentrations were significantly higher than that before operation （P 〈 0.05）after surgery, 1D returned to normal level; adrenocorticotropic hormone concentration had no obvious change in A group during the perioperative period;the time of anesthesia in two groups, There was no significant difference in operation time, waking time, extubation time and incidence of adversereactions （P 〉 0.05）. Conclusion the controlled intravenous infusion of etomidate on hemodynamics in children has little effect, rapid onset, rapidrecovery, can effectively inhibit the peri operative period of children with all kinds of stress reaction, safe and effective, worthy of clinical use.