不同剂量瑞芬太尼联合丙泊酚麻醉诱导用于患儿喉罩置入的临床效果

Clinical effects of different dosage remifentanil combined with propofol anesthesia induction in children with laryngeal mask placement

目的探讨不同剂量瑞芬太尼联合丙泊酚麻醉诱导用于患儿喉罩置入的临床效果。方法以2014年2月-2015年6月在本院行择期手术的90例患儿为研究对象,按瑞芬太尼静脉注射剂量分为A组（1μg/kg,30例）、B组（1.5μg/kg,30例）及C组（2μg/kg,30例）,同时给予3 mg/kg丙泊酚静脉注射麻醉,观察患儿麻醉诱导前（T0）、麻醉诱导后（T1）、置入喉罩时（T2）、置入喉罩后60 s（T3）的平均动脉压（MAP）与心率（HR）变化以及置入喉罩时间和置入喉罩成功率。结果 T0和T1时刻,三组间的MAP、HR比较,差异无统计学意义（P〉0.05）;T2和T3时刻,三组间的MAP、HR比较,差异有统计学意义（P〈0.05）,其中A组和B组的MAP与HR均低于C组相应水平,差异有统计学意义（P〈0.05）;与T0时刻比较,T1时刻MAP、HR明显下降,与T1时刻比较,T2和T3时刻的MAP、HR显著升高,差异有统计学意义（P〈0.05）;三组置入喉罩时间比较差异有统计学意义（P〈0.05）,其中C组置入喉罩时间明显短于A、B组,差异有统计学意义（P〈0.05）,A、B、C组首次置入喉罩成功率分别为70.0%、76.7%、96.6%,差异有统计学意义（P〈0.05）,其中C组置入喉罩成功率明显高于A、B组,差异有统计学意义（P〈0.05）。结论 3 mg/kg丙泊酚与2μg/kg瑞芬太尼作为患儿喉罩置入的麻醉诱导可获得更为稳定的血流动力学及更高的首次喉罩置入成功率。

Objective To explore the clinical effects of different dosage remifentanil combined with propofol anesthesia induction in children with laryngeal mask placement. Methods 90 children undergoing elective surgery in our hospital from February 2014 to June 2015 were selected as study objects.Patients were divided into group A（1 μg/kg,30 cases）,group B（1.5 μg/kg,30 cases） and group C（2 μg/kg,30 cases） according to intravenous dosage of remifentanil.At the same time,propofol 3 mg/kg was used for intravenous anesthesia.The changes of mean arterial pressure（MAP） and heart rate（HR）,placing laryngeal mask time and success rate of placing laryngeal mask of patients at before anesthesia induction（T0）,after anesthesia induction（T1）,placing laryngeal mask（T2） and 60 s after placing laryngeal mask（T3） were observed.Results The MAP and HR at T0 and T1had no statistical significance among three groups（P〈0.05）,the MAP and HR at T2 and T3had statistical significance among three groups（P〈0.05）.The MAP and HR in group A and group B at T2 and T3was lower than the corresponding level of group C respectively,and the difference was statistical significance（P 0.05）.Compared with T0,the MAP and HR obvious decreased at T1;Compared with T1,which increased obviously at T2 and T3,and the difference was statistical significance（P〈0.05）.The placing laryngeal mask time had statistical significance among three groups（P 0.05）.The placing laryngeal mask time in group C was obvious less than group A and group B,and the difference was statistical significance（P〈0.05）.The success rate of first time placing laryngeal mask in group A,group B and group C was respectively 70.0%,76.7% and 96.6%,and the difference was statistical significance（P〈0.05）.The placing laryngeal mask time in group C was obvious longer than that of group A and group B,and the difference was statistical significance（P〈0.05）. Conclusion 3 mg/kg propofol and 2 μg/kg remifentanil as anesthesia induction for children placing laryngeal mask can get more stable hemodynamics and higher success rate of first time placing laryngeal mask.