CAJ | 학술논문

目的：研究不同剂量瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸的影响。方法选择行斜视矫正手术的患儿120例，根据术中给予瑞芬太尼的剂量，将患儿随机均分为生理盐水组（C组），瑞芬太尼0.03μg·kg-1· min-1组（L组）、0.06μg·kg-1·min-1组（M组）和0.09μg·kg-1·min-1组（H组）。观察喉罩置入后（T1）、静注负荷量后（T2）、持续输注10 min（T3）、持续输注15 min（T4）、拔出喉罩（T5）时患儿呼吸频率（RR）、潮气量（VT）、分钟通气量（MV）、呼末CO2分压[p（CO2）]、平均动脉压（MBP）和心率（HR）等指标。记录手术、麻醉时间和术中不良反应等情况。结果4组年龄、体质量、麻醉时间和手术时间，以及不同时点HR和MBP差异均无统计学意义；且均无体动和低氧血症的发生。H组T3、T4、T5时RR和MV明显低于其他3组，T3、T4时p（CO2）高于其他3组（均P＜0.05）；L组和M组T3、T4、T5时RR均低于C组，T3、T4时MV均低于C组，T4时p（CO2）均高于C组（均P＜0.05）；L组和M组间差异均无统计学意义；4组间VT差异无统计学意义。结论0.03~0.09μg·kg-1·min-1瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸具有抑制作用，主要表现为RR降低。根据手术需要输注0.03~0.06μg·kg-1·min-1瑞芬太尼，既可保留患儿自主呼吸，又可减少对呼吸的抑制作用。
목적：연구불동제량서분태니지속수주대소인칠불완마취하자주호흡적영향。방법선택행사시교정수술적환인120례，근거술중급여서분태니적제량，장환인수궤균분위생리염수조（C조），서분태니0.03μg·kg-1· min-1조（L조）、0.06μg·kg-1·min-1조（M조）화0.09μg·kg-1·min-1조（H조）。관찰후조치입후（T1）、정주부하량후（T2）、지속수주10 min（T3）、지속수주15 min（T4）、발출후조（T5）시환인호흡빈솔（RR）、조기량（VT）、분종통기량（MV）、호말CO2분압[p（CO2）]、평균동맥압（MBP）화심솔（HR）등지표。기록수술、마취시간화술중불량반응등정황。결과4조년령、체질량、마취시간화수술시간，이급불동시점HR화MBP차이균무통계학의의；차균무체동화저양혈증적발생。H조T3、T4、T5시RR화MV명현저우기타3조，T3、T4시p（CO2）고우기타3조（균P＜0.05）；L조화M조T3、T4、T5시RR균저우C조，T3、T4시MV균저우C조，T4시p（CO2）균고우C조（균P＜0.05）；L조화M조간차이균무통계학의의；4조간VT차이무통계학의의。결론0.03~0.09μg·kg-1·min-1서분태니지속수주대소인칠불완마취하자주호흡구유억제작용，주요표현위RR강저。근거수술수요수주0.03~0.06μg·kg-1·min-1서분태니，기가보류환인자주호흡，우가감소대호흡적억제작용。
Objective To investigate the effects of different infusion rates of remifentanil infusion on spontaneous ventilation in children received sevoflurane anesthesia. Methods A total of 120 children underwent strabismus surgery were randomly assigned to four groups: C group (administration of saline), L group (remifentanil 0.03 μg · kg-1 · min-1), M group (remifentanil 0.06μg · kg-1 · min-1) and H group (remifentanil 0.09μg · kg-1 · min-1). The mean blood pressure (MBP), heart rate (HR), respiratory rate (RR), tidal volume (VT), minute ventilation (MV), endtidal CO2 [p(CO2)] and endtidal SEV were recorded after laryngeal mask insertion (T1), an initial bolus dose of remifentanil (T2),10 mins after remifentanil infu-sion (T3),15 mins after remifentanil infusion (T4) and laryngeal mask remove (T5) respectively. The adverse events and time of induction, maintenance and emergence were also recoded. Results There were no significant differences in patient age, body mass index, anesthesia time, operation time, HR and MBP at different time points between four groups. No body movement and hypoxemia were observed. The values of RR and MV at T3, T4 and T5 were significantly lower in H group than those of other three groups (P <0.05). Values of p(CO2)at T3 and T4 were significantly higher in H group than those of other three groups (P<0.05). The values of RR at T3, T4 and T5 were significantly lower in L group and M group than those of C group. The values of MV at T3 and T4 were significantly lower in L group and M group than those of C group. p(CO2)at T4 was significantly higher in L group and M group than that of C group(P<0.05), but no significant difference was found be-tween L group and M group. There was no significant difference in value of VT between four groups. Conclusion Remifent-anil infusion at a rate of 0.03~0.09μg·kg-1·min-1 could depress spontaneous ventilation in children received sevoflurane an-esthesia. The respiratory depression effect is mainly manifested by reduction of RR. It is a good option to choose 0.03~0.06μg · kg-1 · min-1 infusion to keep spontaneous ventilation and avoid severe respiratory depression according to the demand of operations in children.