丙泊酚复合雷米芬太尼静脉麻醉用于小儿的临床观察  

Clinical observation of intravenous anesthesia with remifentanil and propofol in pediatric patients

作　　者：张建敏[1] 王芳[1] 辛忠[1] 訾婷婷[1] 吕红[1] 

机构地区：[1]首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《临床麻醉学杂志》2008年第2期123-125,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨丙泊酚复合雷米芬太尼静脉麻醉在不同年龄患儿中的影响。方法ASAI或Ⅱ级全麻插管手术的患儿40例，根据年龄分为四组，每组10例。A组≤3月；B组〉3月～≤2岁；C组〉2岁～≤6岁；D组〉6岁～≤12岁。采用丙泊酚3mg／kg、雷米芬太尼1μg／kg、维库溴铵0．1mg／kg诱导，丙泊酚6mg·kg^-1·h^-1、雷米芬太尼0．25μg·kg^-1·min^-1持续静脉输入维持，记录诱导前（T1）、诱导后（T2）、插管时（T1）、切皮时（T4）、停药时（T5）、自主呼吸恢复时（T4）和拔管时（T7）的血流动力学变化、脑电双频指数（BIS）、95％边缘频率（95％SEF）及镇静评分（UMSS评分）；记录自主呼吸恢复和气管拔管的时间。结果（1）四组患儿T2、T4、T5和T6时，SBP、DBP、HR与T1相比均明显下降（P〈0．01）；T3、T7与T2相比SBP、DBP、HR升高，与T1相比差异无统计学意义；（2）四组患儿停药到自主呼吸恢复时间差异无统计学意义，A组与B、C、D组相比停药到拔管时间明显延长（P〈0．01），B组长于C组（P〈0．05）；（3）四组患儿在T2～T6时BIS下降明显（P〈0．05或P〈0．01），T7时恢复到T1水平，A组患儿在T2～T6时95％SEF较T1时明显下降（P〈0．01），T7时恢复到T1水平；（4）T1时，所有患儿的UMSS评分为0～1分，T2～T6时的UMSS评分为4分，T2时UMSS评分为0～1分。结论 丙泊酚复合雷米芬太尼静脉麻醉在不同年龄患儿使用，诱导平稳、安全；3个月以上患儿苏醒迅速。Objective To investigate the effect of intravenous anesthesia with remifentanil and propofol in different ages of pediatric patients. Methods Forty ASA class Ⅰor Ⅱ pediatric patients undergoings selective surgery were divided into 4 age groups with 10 patients each： group A（≤3 months old）,B（〉3 months to 42 years old）,C（〉2 to 46 years old）,D（〉6 to ≤12 years old）. Anesthesia was induced with remifentanil 1 μg/kg and propofol 3 mg/kg, and maintained with remifentanil 0. 25μg · kg^-1· min^-1 and propofol 6 mg · kg^-1· h^-1. The hemodynamics,BIS values and sedation （UMSS） scores before induction（T1 ）,after induction（T2 ）,intubation（T3 ）,skin incision （T4） ,stopping anesthetics （T5）and recovery of spontaneous respiration（T6 ） and extubation（T7 ） were recorded. The times from T5 to T7 were recorded as well. Results SBP,DBP and HR in all groups at T2 ,T4 ,T5 and T6 decreased significantly compared with those at T2 （P〈0. 01 ）. There were no significant differences in the recovery time among 4 groups. The time of extubation in group A was much longer than that in group B,C,D（P〈0. 01 ）. The BIS value decreased significantly at T2, T3, T4 ,T5 and T6 in all groups compared with that at T1 （P〈0. 01 ）. UMSS scores at T2 and T7 were lower than those at T5 in all groups. Conclusion Anesthesia induction with remifentanil and propofol in different ages of pediatric patients is safe and smooth. The recovery from anesthesia is quicker in patients greater than 3 months old than that in those less.

关 键 词：丙泊酚 雷米芬太尼 脑电双频指数 镇静评分 

分 类 号：R726.1[医药卫生—儿科]