七氟烷抑制全麻患儿喉罩通气道拔除反应的最低肺泡有效浓度  

Minimum alveolar concentration of sevoflurane for blunting the responses to removal of laryngeal mask airway in anesthetized children

作　　者：贺琳[1] 张学锋[1] 

机构地区：[1]复旦大学附属儿科医院麻醉科,上海市200032

出　　处：《中华麻醉学杂志》2008年第12期1071-1073,共3页Chinese Journal of Anesthesiology

摘　　要：目的确定七氟烷抑制全麻患儿喉罩通气道拔除反应的最低肺泡有效浓度（MAC）。方法择期全麻手术患儿25例，ASAⅠ或Ⅱ级，年龄3～8岁。吸入8％七氟烷麻醉诱导后置入喉罩，吸入3％七氟烷维持麻醉。术中均保留自主呼吸。术毕吸除口腔分泌物后维持预定七氟烷浓度10min，采用序贯法调整七氟烷浓度，初始呼气末七氟烷浓度为1％，相邻浓度比值为1．2，喉罩通气道拔除反应阳性时，则下一例患儿升高1个浓度梯度；喉罩通气道拔除反应阴性时，则下一例患儿降低1个浓度梯度。拔除喉罩后1min内患儿出现有目的性的肢体运动、屏气、喉痉挛和低氧血症（SpO2〈95％）为喉罩通气道拔除反应阳性，否则为阴性。将阳性反应到阴性反应的中点设为平衡点，计算所有平衡点七氟烷浓度的平均值，即为MAC。结果七氟烷抑制喉罩通气道拔除反应的MAC为0．98％。结论七氟烷抑制全麻患儿（3～8岁）喉罩通气道拔除反应的最低肺泡有效浓度为0．98％。Objective To determine the minimum alveolar concentration （MAC） of sevoflurane for blunting the responses to removal of the laryngeal mask airway （LMA） in 50% anesthetized children. Methods Twenty-five ASA Ⅰ or Ⅱ children aged 3-8 yr undergoing elective surgery under general anesthesia were enrolled in this study. Anesthesia was induced with inhalation of 8 % sevoflurane. LMA was inserted when the children lost eyelash reflex and the lower jaw was relaxed. Anesthesia was maintained with 3 % sevoflurane. All the children kept spontaneous breathing during operation. Assisted ventilation was performed when necessary to maintain PEr CO2 at 35-45 mm Hg. After the surgery the target end-tidal sevoflurane concentration was maintained for 10 min before LMA was removed. Up-and-down sequential allocation was used to determine the MAC. The initial end-tidal concentration was 1% and was increased/decreased by 20% in the next patient if the extubation response was positive or negative. Limb movement, breath-holding, laryngospasm and hypexemia （SpO2 〈 95% ） were considered to be the signs of positive response. The midpoint from positive response to negative response was made the balance point, and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MAC. Results The end-tidal sevoflurane concentration for blunting the responses to removal of LMA was 0.98 %. Conclusion The MAC of sevoflurane for blunting the responses to removal of LMA in 50 % anesthetized children （aged 3-8 yr） is 0.98% .

关 键 词：喉面罩 剂量效应关系 药物 儿童 七氟醚 

分 类 号：R614[医药卫生—麻醉学] R726.14[医药卫生—外科学]