北京医学
北京醫學
북경의학
BEIJING MEDICAL JOURNAL
2014年
8期
656-658
,共3页
儿童%脑瘫手术%麻醉诱导%丙泊酚%瑞芬太尼%无肌松%气管插管
兒童%腦癱手術%痳醉誘導%丙泊酚%瑞芬太尼%無肌鬆%氣管插管
인동%뇌탄수술%마취유도%병박분%서분태니%무기송%기관삽관
Children%Cerebral palsy operation%Anesthesia induction%Propofol%Remifentanil%With-out muscle relaxants%Tracheal intubation
目的：评价在不使用肌松药情况下不同剂量瑞芬太尼复合舒芬太尼减轻脑瘫小儿经口气管插管心血管反应的效果。方法60例行择期手术脑瘫患儿，随机均分为3组，瑞芬太尼用量分别为2μg/kg组（R1组），4μg/kg组（R2组），6μg/kg组（R3组）。诱导给予丙泊酚（3 mg/kg）和舒芬太尼（0.3μg/kg）后分别静脉输注3个不同剂量的瑞芬太尼行气管插管，分别于麻醉诱导前，气管插管前即刻，插管后1 min、3 min记录平均动脉压和心率，并对插管条件进行评估。结果诱导后各组心率、血压均有下降，以R2和R3组尤其明显，平均动脉压显著下降则见于R3组；R1组患儿插管后与插管前即刻相比心率与血压明显升高。R1组气管插管条件满意率低于R2、R3组（70%vs.95%、100%， P<0.05），但R2、R3组间差异无统计学意义（P>0.05）。结论瑞芬太尼4μg/kg复合丙泊酚、舒芬太尼用于脑瘫小儿无肌松药直接喉镜经口气管插管时，麻醉诱导平稳、安全，可提供满意的气管插管条件。
目的：評價在不使用肌鬆藥情況下不同劑量瑞芬太尼複閤舒芬太尼減輕腦癱小兒經口氣管插管心血管反應的效果。方法60例行擇期手術腦癱患兒，隨機均分為3組，瑞芬太尼用量分彆為2μg/kg組（R1組），4μg/kg組（R2組），6μg/kg組（R3組）。誘導給予丙泊酚（3 mg/kg）和舒芬太尼（0.3μg/kg）後分彆靜脈輸註3箇不同劑量的瑞芬太尼行氣管插管，分彆于痳醉誘導前，氣管插管前即刻，插管後1 min、3 min記錄平均動脈壓和心率，併對插管條件進行評估。結果誘導後各組心率、血壓均有下降，以R2和R3組尤其明顯，平均動脈壓顯著下降則見于R3組；R1組患兒插管後與插管前即刻相比心率與血壓明顯升高。R1組氣管插管條件滿意率低于R2、R3組（70%vs.95%、100%， P<0.05），但R2、R3組間差異無統計學意義（P>0.05）。結論瑞芬太尼4μg/kg複閤丙泊酚、舒芬太尼用于腦癱小兒無肌鬆藥直接喉鏡經口氣管插管時，痳醉誘導平穩、安全，可提供滿意的氣管插管條件。
목적：평개재불사용기송약정황하불동제량서분태니복합서분태니감경뇌탄소인경구기관삽관심혈관반응적효과。방법60례행택기수술뇌탄환인，수궤균분위3조，서분태니용량분별위2μg/kg조（R1조），4μg/kg조（R2조），6μg/kg조（R3조）。유도급여병박분（3 mg/kg）화서분태니（0.3μg/kg）후분별정맥수주3개불동제량적서분태니행기관삽관，분별우마취유도전，기관삽관전즉각，삽관후1 min、3 min기록평균동맥압화심솔，병대삽관조건진행평고。결과유도후각조심솔、혈압균유하강，이R2화R3조우기명현，평균동맥압현저하강칙견우R3조；R1조환인삽관후여삽관전즉각상비심솔여혈압명현승고。R1조기관삽관조건만의솔저우R2、R3조（70%vs.95%、100%， P<0.05），단R2、R3조간차이무통계학의의（P>0.05）。결론서분태니4μg/kg복합병박분、서분태니용우뇌탄소인무기송약직접후경경구기관삽관시，마취유도평은、안전，가제공만의적기관삽관조건。
Objective To assess the efficacy of different dosages of remifentanil combined with propofol and sufen-tanil attenuating the cardiovascular response to tracheal intubation in children anesthetized without relaxants, in order to determine the optmial dose of remifentanil for this purpose. Methods Sixty cerebral palsy pediatric patients were assigned into three groups with different doses of remifentanil: group R1(remifentanil 2μg/kg), group R2(remifentanil 4μg/kg), and group R3(remifentanil 6μg/kg). After anesthesia induction with propofol (3 mg/kg) and sufentanil (0.3μg/kg), pumping dif-ferent doses of remifentanil to tracheal intubation. MAP and HR were recorded before induction, before intubation, and at 1 and 3 min after intubation. Intubation conditions were evaluated. Results There was a significant reduction in HR after induction in all groups, especially in group R2 and R3. A significant reduction in MAP after induction in group R3. Tra-cheal intubation was associated with an increase in MAP and HR in Group R1(P<0.05).The satisfactory degree of intuba-tion conditions in group R1 was significantly lower compared to those in group R2 and R3(70%vs. 95%、100%, P<0.05), but there was no significant difference between group R2 and R3 (P>0.05). Conclusion Remifentanil 4μg/kg combined with propofol and sufentanil without relaxants can provide clinically acceptable tracheal intuhation conditions and stable hemodynamics.
