瑞芬太尼不同剂量持续输注对小儿七氟醚麻醉下自主呼吸的影响

Effects of different doses of continuous infusion of remifentanil on spontaneous respiration of children under sevoflurane anesthesia

目的观察瑞芬太尼不同剂量持续输注对小儿七氟醚麻醉下自主呼吸的影响。方法选取2016年1月至12月湖南省儿童医院腹股沟斜疝修补术患儿126例为研究对象,随机分为高剂量组和低剂量组各63例。患儿吸入8%七氟醚,待患儿深度麻醉后,把七氟醚药物浓度降低,并选取正确型号的喉罩置入,当患儿呼气末七氟烷浓度达到1.3%时,开始给予患儿1μg/kg瑞芬太尼静脉滴注(时间>1min)。之后高剂量组采用0.08μg/kg的瑞芬太尼持续泵注,低剂量组采用0.04μg/kg的瑞芬太尼持续泵注。观察两组患儿喉罩置入之后(T1),静脉滴注瑞芬太尼之后(T2),持续泵注10min之后(T3),持续泵注15min之后(T4)和拔出喉罩之后(T5)的呼吸频率、通气量、潮气量和PCO2。结果在T3~T5时间段高剂量组患儿的呼吸频率、通气量显著低于低剂量组,差异有统计学意义(P<0.05)。在T3、T4时间段高剂量组患儿PCO2显著高于低剂量组,差异有统计学意义(P<0.05)。两组患儿在不同时间段的潮气量比较,差异无统计学意义(P>0.05)。结论对患儿应用七氟醚联合0.04μg/kg的瑞芬太尼,能够有效改善患儿自主呼吸能力,满足临床需求,值得临床推广应用。

ObjectiveTo observe the effect of continuous infusion of remifentanil at different doses on spontaneous breathing of children under sevoflurane anesthesia.MethodsA total of126cases of inguinal hernia repair in Hunan Children's Hospital from January2016to December were selected as the research subjects.They were divided into high dose group and low dose group by random number table,each with63cases.The children inhaled8%sevoflurane,and the concentration of sevoflurane drugs was lowered when patients were in deep anesthesia;the right type of LM was chosen and the children was given1μg/kg intravenous infusion of remifentanil(>1min)when the concentration of seven halothane of expiratory end was1.3%.After that,the high dose group was treated with0.08g/kg remifentanil by continuous infusion,and the low dose group was treated with0.04g/kg remifentanil by continuous infusion.The RR,MV,VT and PCO2at T1(after LM placement),T2(after intravenous transfusion of remifentanil),T3(10min after continuous infusion),T4(15min after continuous infusion)and T5(after LM removal)of the two groups were observed.ResultsThe RR and VT of the high dose group were significantly lower than those of the low dose group in the period of T3to T5,the difference being statistically significant(P<0.05).In the T3and T4periods,the PCO2in the high dose group being significantly higher than that in the low dose group,the difference being statistically significant(P<0.05).There was no significant difference in VT between the two groups at different time points(P>0.05).ConclusionSevoflurane combined with0.04g/kg remifentanil can effectively improve the ability of spontaneous breathing of children,and meet the clinical needs.It is worthy of clinical application.