不同血浆靶浓度瑞芬太尼对患儿吸入七氟烷诱导气管插管最低肺泡有效浓度的影响  

Effects of different target plasma concentrations of remifentanil on minimum alveolar concentration of sevoflurane for tracheal intubation in children

作　　者：贺琳[1] 张学锋[1] 汤顺荣[1] 王炫[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》2009年第3期200-202,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同血浆靶浓度瑞芬太尼对患儿吸入七氟烷诱导气管插管最低肺泡有效浓度（MAC）的影响。方法择期全麻患儿126例，年龄3～8岁，ASAⅠ或Ⅱ级，随机分为4组，对照组（C组，n=30）；R1组（n=30）、R2组（n=30）和R3组（n=36）瑞芬太尼血浆靶浓度分别为1、2、3ng／ml。均吸入5％七氟烷行麻醉诱导，睫毛反射消失后鼻腔置入导管连接气体分析仪，建立静脉通路，注射阿托品0．01mg／kg，R1-3组靶控输注瑞芬太尼。C组注射阿托品、R1-3组瑞芬太尼血浆浓度与效应室浓度达平衡后，采用改良序贯法进行试验，初始呼气末七氟烷浓度均为3．0％，相邻浓度比值为1．2，七氟烷呼气末浓度达到预定值并维持10min后行气管插管。气管插管条件满意的标准：气管插管条件评分为6分。计算每组七氟烷MAC，并观察不良反应的发生情况。结果C组、R1-3组患儿吸入七氟烷诱导气管插管的MAC分别为5％、3％、2％、1％，依次降低（P〈0．01）；所有患儿均无心动过缓、低血压等发生，R2组3例、R3组8例患儿因下颌松弛度差致喉镜无法置入或声门关闭，静脉注射罗库溴铵完成气管插管。结论瑞芬太尼1ng／ml可降低患儿吸入七氟烷诱导气管插管的最低肺泡有效浓度，且不良反应少。Objective To investigate the effects of different target plasma concentrations of remifentanil given by TCI on the minimum alveolar concentration （MAC） of sevoflurane for induction of tracheal intubation in children. Methods One hundred and twenty-six ASA Ⅰ or Ⅱ children aged 3-8 yr undergoing elective surgery under general anesthesia were randomly divided into 4 groups ： control group （ C, n = 30 ）, and target plasma concentration of remifentanil 1 ng/ml group （R,, n = 30）, 2 ng/ml group （R2, n = 30） and 3 ng/ml group （R3, n = 36）. Anesthesia was induced with 5% sevofiurane. A catheter connected to gas analyzer was inserted into nasal cavity when the children lost eyelash reflex. Venous access was established, atropine 0.01 mg/kg was injected iv in group C, and remifentanil was given by TCI in group R1-3 . After atropine was injected in group C and the plasma and effect-site concentrations of remifentanil reached the balance, the up-and-down sequential experiment was performed. The initial end-tidal concentration of sevoflurane was 3 % and the ratio of the two successive concentrations was 1.2. After the end-tidal concentration of sevoflurane reached the predetermined value, it was maintained for 10 min and tracheal intubation was then performed. Satisfactory tracheal intubation condition was defined as the intnbation score = 6. MAC of sevoflurane in each group was calculated. Adverse effects were also recorded. Results The MAC of sevoflurane for tracheal intubation was 5 % , 3 %, 2 % and 1% in group C and R1-3 respectively. No bradycardia and hypotension occurred in all the children. Tracheal intubation of 3 cases in group R2 and 8 cases in group R3 was facilitated with iv injection of vecuronium because laryngoscope could not be inserted or the glottis was closed. Conclusion Remifentanil 1 ng/ml can reduce the MAC of sevoflurane for tracheal intubation and has less adverse effect in children.

关 键 词：哌啶类 药物释放系统 麻醉药 吸入 剂量效应关系 药物 插管法 气管内 儿童 

分 类 号：R614[医药卫生—麻醉学] R651.15[医药卫生—外科学]