不同小剂量舒芬太尼对患儿经口气管插管心血管反应的影响  

Effects of Different Small-Dose Sufentanil on Cardiovascular Responses to Orotracheal Intubation in Children

作　　者：罗茂萍[1] 薛富善[1] 刘毅[1] 许亚超[1] 杨泉涌[1] 廖旭[1] 刘建华[1] 张雁鸣[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院麻醉科,北京100144

出　　处：《实用儿科临床杂志》2009年第17期1369-1372,共4页Journal of Applied Clinical Pediatrics

摘　　要：目的评价不同小剂量舒芬太尼减轻患儿经口气管插管心血管反应的效果,以确定用于该目的的最佳舒芬太尼剂量。方法选择美国麻醉医师协会(ASA)身体状况分级为Ⅰ级、拟在经口气管插管全身麻醉下施择期整形外科手术的患儿165例,随机分为4组:Ⅰ组为对照组,Ⅱ～Ⅳ组为治疗组。在丙泊酚和维库溴铵麻醉诱导前,采用盲法分别予Ⅰ～Ⅳ组单次静脉应用9 g/L盐水5 mL,舒芬太尼0.1、0.2和0.3μg/kg。记录麻醉诱导前(基础值)、后(麻醉诱导后值),气管插管时和气管插管5 min内(间隔时间为1 min)的BP和HR,计算各观察时间点收缩压(SBP)和HR相对于基础值的变化率,并记录观察期SBP和HR达最大值的时间及其气管插管后恢复至麻醉诱导后值的时间。结果与基础值比较,气管插管导致Ⅰ、Ⅱ和Ⅲ组的BP和HR显著增高,但Ⅳ组的BP和HR无显著改变。气管插管时的BP和HR及观察期其最大值在4组之间比较均有显著性差异。观察期SBP和HR最大增加的百分率在Ⅰ组分别为24%和37%;Ⅱ组分别为20%和28%;Ⅲ组分别为13%和13%;Ⅳ组分别为0和4%。除Ⅲ组和Ⅳ组比较外,观察期SBP和HR增加超过基础值30%的发生率在4组间比较均具有显著性差异,但SBP和HR降低大于基础值30%的发生率在4组间比较则无显著性差异。观察期SBP和HR达最大值的时间在4组间无显著性差异。除Ⅲ组和Ⅳ组比较外,气管插管后SBP和HR恢复至麻醉诱导后值的时间在4组间比较均具有显著性差异。结论小儿联合应用丙泊酚实施麻醉诱导时,单次静脉应用舒芬太尼可呈剂量相关性的抑制经口气管插管心血管反应,舒芬太尼0.3μg/kg可完全消除经口气管插管的心血管反应,且无更多的不良血流动力学影响。Objective To assess the efficacy of different small - dose sufentanil attenuating the cardiovascular response to orotracheal intubation in children, aiming at determining the optimal dose of sufentanil for this purpose. Methods One hundred and sixty - five children, American Society of Anesthesiologists （ASA） physical status Ⅰ , scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation,were randomly divided into 4 groups ：group Ⅰ was as control group, and Groups Ⅱ to Ⅳ were assigned as treatment groups. Before anesthesia induction with propofol and vecuronium, normal saline 5 mL, and sufentanil 0.1,0.2 and 0.3 μg/kg were intravenously administrated as a bolus in groups Ⅰ to Ⅳ ,respectively,in a blind way. Noninvasive blood pressure（BP） and heart rate（HR） were recorded before （ baseline values） and after anesthesia induction （ postinduction values） ,at intubation and every minute for 5 min after intubation. The percent changes of systolic blood pressure （SBP） and HR relative to baseline values at every measuring point were calculated. Times required for the occurrence of the maximum values of SBP and HR during the observation, and times required for the recovery of SBP and HR to postinduction values after intubation were also recorded. Results Except for group Ⅳ, tracheal intubation caused significant increases BP and HR in group Ⅰ , Ⅱ ,and Ⅲ compared with baseline values. BP and HR at intubation and their maximum values during the observation were significantly different among the 4 groups. The maximum percent increase of SBP and HR during the observation were 20% and 28% of the baseline values,respectively,in group Ⅱ ;13% and 13% in group Ⅲ ;and 0 and 4% in group Ⅳ compared with 24% and 37% in group Ⅰ. Except for the group m vs group Ⅳ comparison, the incidences of SBP and HR percent increases 〉 30% of baseline values were significantly different among the 4 groups. The 4 groups were similar with respect to the inci

关 键 词：舒芬太尼 全身麻醉 经口气管插管 心血管反应 儿童 

分 类 号：R726.1[医药卫生—儿科]