小剂量芬太尼预防小儿直接喉镜经口气管插管心血管反应的效果  

Effect of Small Dose Fentanyl Blunting Cardiovascular Response to Laryngoscopic Orotracheal Intubation in Children

作　　者：李平[1] 薛富善[1] 刘毅[1] 刘鲲鹏[1] 许亚超[1] 张国华[1] 李成文[1] 孙海涛[1] 

机构地区：[1]中国医学科学院中国协和医科大学整形外科医院麻醉科,北京100041

出　　处：《实用儿科临床杂志》2006年第15期1031-1033,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的 观察小剂量芬太尼对小儿直接喉镜经口气管插管心血管反应的预防效果。方法 选择65例施择期整形外科手术的小儿。随机分为为对照组（Ⅰ组）和芬太尼组（Ⅱ组），在气管插管前5min，Ⅰ和Ⅱ组分别静脉注射生理盐水0．2mL／kg和芬太尼2μg／kg，在直接喉镜经口气管插管操作前2min静脉注射维库溴铵0．1mg／kg和丙泊酚2．5mg／kg进行全身麻醉诱导。观察麻醉诱导前（基础值）后，气管插管时和气管插管后5min内血压、心率（HR）和二重指数（RPP）变化，并记录气管插管时间。结果 血压、心率和RPP的基础值以及气管插管时间两组均无显著性差异。直接喉镜经几气管插管导致两组的血压、心率和RPP均较基础值显著升高。与Ⅱ组相比，Ⅰ组直接喉镜经口气管插管的心血管反应更强烈和持续时间更长。Ⅰ组气管插管时和气管插管后1-4min血压和RPP及观察期其最大值显著高于Ⅱ组。Ⅰ组气管插管时和气管插管后1min心率及观察期心率的最大值亦显著高于Ⅱ组。Ⅱ组舒张压、心率和RPP最大增加均超过基础值20％。结论 虽然静脉注射芬太尼2μg／kg能明显减轻小儿直接喉镜经口气管插管时的血压增高和心率增快反应，但并不能达到完全抑制效果。Objective To observe whether small dose fentanyl can effectively blunt the cardiovascular response to laryngoscopic orotracheal intubation in children. Methods Sixty-five ASA grade Ⅰ-Ⅱ children undergoing elective plastic surgery and requiring orotracheal intubation were randomly allocated to either control group （Group Ⅰ ）or fentanyl group（Group Ⅱ ）. Five minutes before intubation, saline 0.2 mL/kg in Group I and fentanyl 2 μg/kg in Group Ⅱ were administered i. v. , then vecuronitml 0.1 mg/kg and propofol 2.5 mg/kg were administered 2 minutes before the laryngoscopic orotracheal intubation was performed. Noninvasive blood pressure, heart rate（HR） and rate-pressure produet（RPP）were recorded before（baseline values） and after anesthetic induction, at intubation and 5 minutes after intubation at 1-minute interval. Results There were no significant differences between the 2 groups in the baseline values of blood pressures, FIR and RPP,and the intubation time. In the 2 groups, the orotracheal intubation caused the significant increases in blood pressures, FIR and RPP compared to the baseline values. As compared to Group Ⅱ , the cardiovascular response to orotracheal intubation was stronger and longer in Group Ⅰ . The blood pressures and RPP at intubation and 1-4 minutes after intubation were significantly higher in Group Ⅰ than in Group Ⅱ . FIR at intubation and 1 min after intubation were also larger in Group 1 than in Group Ⅱ . However, the maximal increases of DBP, FIR and RPP during the observation in Group Ⅱ were more than 20% of their baseline values. Conclusions The intravenous administration of fentanyl 2 μg/kg can significantly attenuate the pressor and tachycardiac responses to laryngoscopic orotracheal intubation in healthy children, but cannot completely obviate them.

关 键 词：芬太尼 儿童 全身麻醉 经口气管插管 心血管反应 

分 类 号：R726.1[医药卫生—儿科]