不同剂量异丙酚复合瑞芬太尼对脑瘫患儿非肌松气管插管条件满意度的影响  

Effect of different doses of propofol combined with remifentanil on the condition of non muscle relaxation in children with cerebral palsy

作　　者：林艳君[1] 杨占民[1] 

机构地区：[1]北京大学航天中心医院麻醉科,北京市100039

出　　处：《临床合理用药杂志》2015年第26期31-32,34,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的探讨不同剂量异丙酚复合瑞芬太尼对脑瘫患儿非肌松气管插管条件满意度的影响。方法选取择期全麻下行选择性外周神经部分切断术的痉挛性脑瘫患儿80例,随机分为Ⅰ组（异丙酚3mg/kg＋瑞芬太尼3μg/kg）、Ⅱ组（异丙酚3mg/kg＋瑞芬太尼4μg/kg）、Ⅲ组（异丙酚4mg/kg＋瑞芬太尼3μg/kg）及Ⅳ组（异丙酚4mg/kg＋瑞芬太尼4μg/kg）各20例。经开放的上肢静脉依序缓慢静脉推注相应剂量的异丙酚（20s）和瑞芬太尼（60s）,于瑞芬太尼注射后60s用Macintosh直接喉镜行气管插管。观察气管插管条件的满意度。结果 4组均一次插管成功。Ⅰ组插管满意8例（40.0%）显著低于其他3组,Ⅳ组插管满意20例（100.0%）明显较其他3组高,差异有统计学意义（P〈0.05）。Ⅱ组插管满意15例（75.0%）与Ⅲ组16例（80.0%）比较差异无统计学意义（P〉0.05）。各组患儿插管前血压及心率均明显低于基础值,比较差异有统计学意义（P〈0.05）。Ⅰ组插管后血压、心率明显高于插管前,比较差异有统计学意义（P〈0.05）;其他3组插管前、后血压及心率比较差异无统计学意义（P〉0.05）。结论在未使用肌松药条件下,3mg/kg异丙酚复合4μg/kg瑞芬太尼和4mg/kg异丙酚复合3～4μg/kg瑞芬太尼能有效抑制气管插管前后引起的心血管反应且可获得满意的气管插管条件。Objective To investigate the effect of different doses of propofol combined with remifentanil on the satis- faction of the patients with cerebral palsy in the condition of non muscle relaxation. Methods 80 children with cerebral palsy were randomly divided into 4 groups, as Ⅰ （propofol 3mg/kg with remifentanil 3 μg/kg ）, Ⅱ （propofol 3mg/kg with remifentanil 4 μg/kg ）, Ⅲ （ propofol 4mg/kg with remifentanil 3 μg/kg ）and IV （propofol 4mg/kg with remifentanil 4 μg/kg）. The correspond- ing dose of propofol （20s） and remifentanil （60s） were intravenously injected in turn in each group. 60 seconds after the in- jection of remifentanil, tracheal intubation was performed. To observe the degree of satisfaction of tracheal intubation. Results Tracheal intubations were performed successfully in all groups. The satisfactory rates were 40%, were also better than those75% ,80% and 100% in group Ⅰ , Ⅱ, Ⅲ and Ⅳ respectively. Comparedwith group Ⅰ,intubation conditions were much bet- ter in group Ⅱ, Ⅲ and Ⅳ, and the intubation conditions in group IV were also better than thosein group Ⅱ and Ⅲ. Blood pressures and heart rates were decreased in all groups after anesthesia induction. In group Ⅰ,they all increased after intubation while other groups were not. Conclusion Without muscle relaxant, the satisfied intubation conditions can be provided when remifentanil 3 ～ 4μg/kg and propofol 4 mg/kg or remifentani14μg/kg and propofol3 mg/kg were administered which also have little changes in blood pressures and heart rates in children with cerebral palsy.

关 键 词：异丙酚 瑞芬太尼 气管插管 脑瘫 

分 类 号：R726.1[医药卫生—儿科]