瑞芬太尼复合七氟醚在新生儿全身麻醉中的应用  

Application of remifentanil combined with sevoflurance anesthesia in neonates

作　　者：李立晶[1] 张建敏[1] 王芳[1] 郝唯[1] 

机构地区：[1]100045首都医科大学附属北京儿童医院麻醉科

出　　处：《临床麻醉学杂志》2014年第1期21-23,共3页Journal of Clinical Anesthesiology

摘　　要：目的 观察瑞芬太尼复合七氟醚在新生儿全身麻醉中应用的安全性及有效性.方法 40例择期行腹部手术的足月新生儿,年龄3～28 d,随机均分为瑞芬太尼复合七氟醚维持麻醉组（A组）和单纯七氟醚维持麻醉组（B组）.两组均给予七氟醚诱导,气管插管后,A组静脉泵入瑞芬太尼0.33 μg·kg-1·min-1,两组均根据患儿临床表现（HR、BP、体动、呼吸对抗）调节七氟醚浓度.A组在术毕前约15 min停止泵入瑞芬太尼,两组均于手术结束时停止吸入七氟醚.记录入室时（T1）、手术开始前即刻（T2）、手术开始后10 min（T3）、60 min （T4）、拔除气管导管时（Ts）患儿的HR、MAP、呼气末七氟醚浓度（CETSev）,并记录患儿的拔管时间及不良反应.结果 T3～T5时A组HR明显慢于B组（P＜0.05）;T3时A组MAP明显低于B组（P＜0.05）;T2～T4时A组CETTSev明显低于B组（P＜0.05）.两组拔管时间差异无统计学意义.无低血压、严重心动过缓等不良反应.结论 瑞芬太尼复合七氟醚用于新生儿可以提供满意的麻醉效果,减少吸入麻醉药用量,不良反应少.Objective To observe the efficacy and safety of remifentanil-sevoflurane anesthesia in neonates.Methods Forty full-term neonates of 3-28 d undergoing selective abdominal surgeries were rando mly divided into two groups：group A and B.Patients in group A was induced with sevoflurane and maintained with remifentanil （0.33 μg·kg-1· min-1） combined with sevoflurane and patients in group B was both induced and maintained with sevoflurane.Sevoflurane concentration was regulated according to clinical signs（HR,BP,movements,ventilator resistance）in both groups.Remifentanil was stopped about 15 mins before the end of the surgery and sevoflurane was stopped at the end of surgery.HR,MAP,CETSev were observed at baseline （T1）,before incision （T2） and at 10 min（T3）,60 min（T4） after incision,and during extubation（T5）.Extubation time and side effects were also recorded.Results In group A,HR was lower at T3-T5,and MAP was lower at T3,CETSev was lower at T2-T4 than those in group B.There was no significant difference in extubation time between the two groups.（P〈0.05）.There were no side effects such as hypotension and bradycardia.Conclusion Remifentanil combined with sevoflurane can provide satisfactory anesthetic effect in neonates with reduced inhalational anesthetic and less side effects.

关 键 词：瑞芬太尼 七氟醚 新生儿 

分 类 号：R726.1[医药卫生—儿科]