CAJ | 학술논문

目的评价不同血浆靶浓度瑞芬太尼对患儿吸入七氟烷诱导气管插管最低肺泡有效浓度(MAC)的影响.方法择期全麻患儿126例,年龄3～8岁,ASAⅠ或Ⅱ级,随机分为4组,对照组(C组,n=30);R1组(n=30)、R2组(n=30)和R3组(n=36)瑞芬太尼血浆靶浓度分别为1、2、3 ng/ml.均吸入5%七氟烷行麻醉诱导,睫毛反射消失后鼻腔置入导管连接气体分析仪,建立静脉通路,注射阿托品0.01 mg/kg,R1-3 组靶控输注瑞芬太尼.C组注射阿托品、R1-3组瑞芬太尼血浆浓度与效应室浓度达平衡后,采用改良序贯法进行试验,初始呼气末七氟烷浓度均为3.0%,相邻浓度比值为1.2,七氟烷呼气末浓度达到预定值并维持10 min后行气管插管.气管插管条件满意的标准:气管插管条件评分为6分.计算每组七氟烷MAC,并观察不良反应的发生情况.结果 C组、R1-3组患儿吸入七氟烷诱导气管插管的MAC分别为5%、3%、2%、1%,依次降低(P<0.01);所有患儿均无心动过缓、低血压等发生,R2组3例、R3组8例患儿因下颌松弛度差致喉镜无法置人或声门关闭,静脉注射罗库溴铵完成气管插管.结论瑞芬太尼1 ng/ml可降低患儿吸入七氟烷诱导气管插管的最低肺泡有效浓度,且不良反应少.
목적 평개불동혈장파농도서분태니대환인흡입칠불완유도기관삽관최저폐포유효농도(MAC)적영향.방법 택기전마환인126례,년령3～8세,ASAⅠ혹Ⅱ급,수궤분위4조,대조조(C조,n=30);R1조(n=30)、R2조(n=30)화R3조(n=36)서분태니혈장파농도분별위1、2、3 ng/ml.균흡입5%칠불완행마취유도,첩모반사소실후비강치입도관련접기체분석의,건립정맥통로,주사아탁품0.01 mg/kg,R1-3 조파공수주서분태니.C조주사아탁품、R1-3조서분태니혈장농도여효응실농도체평형후,채용개량서관법진행시험,초시호기말칠불완농도균위3.0%,상린농도비치위1.2,칠불완호기말농도체도예정치병유지10 min후행기관삽관.기관삽관조건만의적표준:기관삽관조건평분위6분.계산매조칠불완MAC,병관찰불량반응적발생정황.결과 C조、R1-3조환인흡입칠불완유도기관삽관적MAC분별위5%、3%、2%、1%,의차강저(P<0.01);소유환인균무심동과완、저혈압등발생,R2조3례、R3조8례환인인하합송이도차치후경무법치인혹성문관폐,정맥주사라고추안완성기관삽관.결론 서분태니1 ng/ml가강저환인흡입칠불완유도기관삽관적최저폐포유효농도,차불량반응소.
Objective To investigate the effects of different target plasma concentrations of remifentanil given by TCI on the minimum alveolar concentration(MAC)of sevoflurane for induction of tracheal intubation in children.Methods One hundred and twenty.six ASA Ⅰ or Ⅱ children aged 3-8 yr undergoing elective surgery under general anesthesia were randomly divided into 4 groups:control group(C,n=30),and target plasma concentration of remifentanil 1 ng/group(R1,n=30),2 ng/ml group(B2,n=30)and 3 ng/ml group(R3,n=36).Anesthesia WM induced with 5% sevoflurane.A catheter connected to gas analyzer was inserted into nasal cavity when the children lost eyelash reflex.Venous access was established,atropine 0.01 mg/kg was injected iv in group C,and remifentanil was given by TCI in group R1-3. After atropine Was injected in group C and the plasma and effect-site concentrations of remifentanil reached the balance,the up-and-down sequential experiment was performed.The initial end-tidal concentration of sevoflurane was and the ratio of the two 8uccessive concentrations was 1.2. After the end.tidal concentration of sevoflurane reached the predetermined value.it was maintained for 10 rain and tracheal intubation Was then performed.Satisfactory tracheal intubation condition was defined as the inlubation score = 6. MAC of sevoflurane in each group was calculated. Adverse effect were also recorded.Results The MAC of sevoflurane for tracheal intubation was 5%,3%,2%and 1% in group C and B1-3 respectively.No bradycardia and hypotension occurred in all the children.Tracheal intubation of 3 cases in group R2 and 8 cases in group R3 Was facilitated with iv injection of vecuronium because laryngoscope could not be inserted or the glottis was closed. Conclusion Remifentanil 1 ng/ml can reduce the MAC of sevoflurane for tracheal intubation and has less adverse effect in children.