北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2014年
8期
659-662
,共4页
小剂量芬太尼%七氟烷%自主呼吸
小劑量芬太尼%七氟烷%自主呼吸
소제량분태니%칠불완%자주호흡
Low-dose fentanyl%Sevoflrane%Spontaneous ventilation
目的：观察小剂量芬太尼对七氟烷麻醉中小儿自主呼吸功能的影响。方法选择ASAⅠ～Ⅱ级拟择期于全麻下行斜视手术的患儿60例，随机分为Ⅰ、Ⅱ组，均吸入8%七氟烷诱导并置入喉罩；3%七氟烷维持麻醉，保留自主呼吸。Ⅱ组在手术开始前静脉滴注1μg/kg芬太尼，Ⅰ组则给予生理盐水1 ml。记录给予芬太尼或生理盐水前（0 min），给药后5 min、10 min、15 min、20 min时的脉搏血氧饱和度（SpO2）、潮气量（VT）、呼吸频率（f）、呼气末二氧化碳分压（PETCO2）。于给药前，给药后20 min和停药后15 min测动脉血气。记录患儿苏醒时间和苏醒期躁动情况。结果Ⅱ组患儿苏醒时间长于Ⅰ组[（9.48±1.99）min vs.（6.53±1.29）min， P﹤0.05]，躁动发生率低[13.3%（4例） vs.40.0%（12例）]。Ⅱ组患儿的呼吸频率在给药后5 min开始减慢，潮气量表现为抑制或代偿性增加，分钟通气量降低。给药后10 min均表现为呼吸频率减慢和潮气量代偿性增加，20 min时恢复至给药前水平。Ⅱ组患儿动脉二氧化碳分压（PaCO2）和PETCO2升高，pH值降低，苏醒期恢复至给药前水平。结论1μg/kg芬太尼使七氟烷麻醉时小儿的呼吸频率减慢，潮气量代偿性增加，最终使分钟通气量下降，导致一过性高碳酸血症，多无需处理。PETCO2监测有助于术中呼吸管理。
目的：觀察小劑量芬太尼對七氟烷痳醉中小兒自主呼吸功能的影響。方法選擇ASAⅠ～Ⅱ級擬擇期于全痳下行斜視手術的患兒60例，隨機分為Ⅰ、Ⅱ組，均吸入8%七氟烷誘導併置入喉罩；3%七氟烷維持痳醉，保留自主呼吸。Ⅱ組在手術開始前靜脈滴註1μg/kg芬太尼，Ⅰ組則給予生理鹽水1 ml。記錄給予芬太尼或生理鹽水前（0 min），給藥後5 min、10 min、15 min、20 min時的脈搏血氧飽和度（SpO2）、潮氣量（VT）、呼吸頻率（f）、呼氣末二氧化碳分壓（PETCO2）。于給藥前，給藥後20 min和停藥後15 min測動脈血氣。記錄患兒囌醒時間和囌醒期躁動情況。結果Ⅱ組患兒囌醒時間長于Ⅰ組[（9.48±1.99）min vs.（6.53±1.29）min， P﹤0.05]，躁動髮生率低[13.3%（4例） vs.40.0%（12例）]。Ⅱ組患兒的呼吸頻率在給藥後5 min開始減慢，潮氣量錶現為抑製或代償性增加，分鐘通氣量降低。給藥後10 min均錶現為呼吸頻率減慢和潮氣量代償性增加，20 min時恢複至給藥前水平。Ⅱ組患兒動脈二氧化碳分壓（PaCO2）和PETCO2升高，pH值降低，囌醒期恢複至給藥前水平。結論1μg/kg芬太尼使七氟烷痳醉時小兒的呼吸頻率減慢，潮氣量代償性增加，最終使分鐘通氣量下降，導緻一過性高碳痠血癥，多無需處理。PETCO2鑑測有助于術中呼吸管理。
목적：관찰소제량분태니대칠불완마취중소인자주호흡공능적영향。방법선택ASAⅠ～Ⅱ급의택기우전마하행사시수술적환인60례，수궤분위Ⅰ、Ⅱ조，균흡입8%칠불완유도병치입후조；3%칠불완유지마취，보류자주호흡。Ⅱ조재수술개시전정맥적주1μg/kg분태니，Ⅰ조칙급여생리염수1 ml。기록급여분태니혹생리염수전（0 min），급약후5 min、10 min、15 min、20 min시적맥박혈양포화도（SpO2）、조기량（VT）、호흡빈솔（f）、호기말이양화탄분압（PETCO2）。우급약전，급약후20 min화정약후15 min측동맥혈기。기록환인소성시간화소성기조동정황。결과Ⅱ조환인소성시간장우Ⅰ조[（9.48±1.99）min vs.（6.53±1.29）min， P﹤0.05]，조동발생솔저[13.3%（4례） vs.40.0%（12례）]。Ⅱ조환인적호흡빈솔재급약후5 min개시감만，조기량표현위억제혹대상성증가，분종통기량강저。급약후10 min균표현위호흡빈솔감만화조기량대상성증가，20 min시회복지급약전수평。Ⅱ조환인동맥이양화탄분압（PaCO2）화PETCO2승고，pH치강저，소성기회복지급약전수평。결론1μg/kg분태니사칠불완마취시소인적호흡빈솔감만，조기량대상성증가，최종사분종통기량하강，도치일과성고탄산혈증，다무수처리。PETCO2감측유조우술중호흡관리。
Objective To evaluate the effects of low-dose fentanyl on children's respiratory function during sevoflurane inhalation with spontaneous ventilation. Methods Sixty children scheduled to receive squint correction opera-tion were randomly assigned into two groups. All children were performed anesthetic induction with 8% sevoflurane and 5%oxygen followed by laryngeal mask airway(LMA) insertion. Anesthetic maintenance was performed with 3% sevoflurane and 2%oxygen, which allowed spontaneous ventilation. 1μg/kg fentanyl in group Ⅱ, or saline in groupⅠwas injected in-travenously before the operation. The respiratory parameters and blood gas data were recorded before and after medication in both groups. Recovery time and emergency agitation were evaluated after sevoflurane inhalation. Results There was no difference in operation time between the two groups. Recovery time in group Ⅱ [(9.48 ±1.99)min] was longer than that in groupⅠ [(6.53±1.29 )min, P﹤0.05]. The incidence of emergency agitation was lower in group Ⅱ (13.3%) compared with groupⅠ (40.0%). Two cases in group Ⅰreceived drug intervention with propofol. There was no change in respiratory pa-rameters after saline injection in group Ⅰ. Respiratory frequency started to decrease 5 min after medication in group Ⅱwhen tidal volume was decreased in some children and compensatory increased in others. The minute ventilation was de-creased significantly after fentanyl usage. All the children in group Ⅱ showed decreased respiratory frequency and com-pensatory increased tidal volume 10 min after medication, which returned to the level of premedication 20 min af-ter medication. Fentanyl didn't cause significant change on PaO2. But PETCO2 and PaCO2 were increased and pH was de-creased correspondingly. There was no need to intervene. Conclusion 1μg/kg fentanyl depresses children's spontaneous respiratory function partially during sevoflurane inhalation, which may lead to transient hypercapnia. The P ETCO2 monitor is useful for children's ventilation management.
