小儿择期手术静脉复合全麻不同剂量瑞芬太尼、丙泊酚全麻维持的量效关系  

Relation of the dosage of remifentanil and propofol used in the maintain stage of general anesthesia in pediatric slective surgery

作　　者：康力[1] 刘华[1] 陈丽[1] 吕东森[1] 袁承城[1] 刘焕结[1] 

机构地区：[1]广东省深圳市宝安区中医院,广东深圳518133

出　　处：《现代中西医结合杂志》2016年第16期1729-1733,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市宝安区科技创新局2013年科研立项资助项目(2013106)

摘　　要：目的探讨小儿择期手术静脉复合全麻维持中不同瑞芬太尼、丙泊酚配伍剂量与麻醉效果的关系。方法选择普外、骨科择期手术接受全麻的1~10岁患儿120例。诱导：2台注射泵分别同时泵注丙泊酚0.15 mg/kg、瑞芬太尼15μg/kg,时间6 min,泵注1 min时静注阿托品0.008 mg/kg,意识消失后静注维库溴胺0.12 mg/kg,泵注结束测量血压、心率后气管插管。维持：依恒速泵注丙泊酚用量的不同分为每小时每千克体质量4 mg组（B_4组）、5mg组（B_5组）、6 mg组（B_6组）、7 mg组（B_7组）、8 mg组（B_8组）、9 mg组（B_9组）共6组,每组20例。瑞芬太尼起始泵速60μg/（kg·h）,调节瑞芬太尼泵速维持全麻中MAP比其基础MAP下降5%左右（不超过10%）至手术结束停药。结果 6组基础MAP平均值均低于其诱导前MAP平均值15%以上。6组维持MAP平均值均达到比其基础MAP值降低5%左右的效果。要达到相同范围内的维持MAP值,随着丙泊酚维持用量逐组增加,瑞芬太尼维持平均用量逐组降低,丙泊酚用量与瑞芬太尼用量呈负相关（r=-0.92,P〈0.05）,瑞芬太尼维持用量各组之间比较差异均有统计学意义（P均〈0.05）,但每组内的瑞芬太尼用量存在较大的个体差异。6组维持MAP稳定指数均比其基础MAP稳定指数降低,维持MAP稳定指数各组间比较差异均无统计学意义,6组维持HR平均值均比其HR基础值降低≤10%,6组维持HR稳定指数均比其基础HR稳定指数降低,B_4组、B_5组、B_6组维持HR稳定指数均显著小于B_7组、B_8组、B_9组（P均〈0.05）。睁眼时间逐组延长,B_4组、B_5组睁眼时间显著短于B_6组、B_7组、B_8组、B_9组（P均〈0.05）,丙泊酚用量与睁眼时间呈正相关（r=0.97,P〈0.05）;全麻维持效果评级：B_4组、B_5组为Ⅰ级,B_6组、B_7组、B_8组为Ⅱ级,B_9组为Ⅲ级。B_4组、B_5组未发生拔管躁动,B_6组的拔管躁动发生率明显低于B_7组、B_8组、B_9组（P均Objective It is to investigate the relation of the dosage of remifentanil and propofol used in the maintain stage of general anesthesia to effect on the pediatric slective surgery. Methods A total of 120 1- 10 years old children undergoing general and orthopatdics surgery were collected. Induction： 15 μg / kg remifentanil and 0. 15 mg / kg propofol were injected by pumps for 6 min. Two pumps were started simultaneously. The children were injected with 0. 007 mg / kg atropine after 1 min,and injected with 0. 12 mg/kg vecuronium bromide for loss of consciousness. The children after taking blood pressure and heart rate were intubated,when the pumps finished injecting. General anesthesia maintentance： According to the different dosage of propofol in the general anesthesia maintentance,the children were randomly and equally grouped into group B_4（ 4 mg）,group B_5（ 5 mg）,group B_6（ 6 mg）,group B_7（ 7 mg）,group B_8（ 8 mg）,group B_9（ 9 mg）. The initial dose of remifentanil was 60 μg / kg. The dose of remifentanil was adjusted to maintain the MAP which was about 5% lower than the basal MAP（ not 10% higher）,continued to the end of surgery. Results The basal MAP of six groups was about 15% more lower than the MAP of before induction. The MAP of six groups in general anesthesia maintenance was about 5% lower than the basal MAP.To achieve maintain value of MAP within the same scope,with the dose of propofol used in general anesthesia maintain increasing,the average dose of remifentanil used in general anesthesia maintain decreased gradually,and the average dose of remifentanil used in general anesthesia maintain. There were significant differences between the dose of remifentanil used in general anesthesia maintain of each group in demographic data（ P〈0. 05 or 0. 01. But there were significant differences in each group. The stable index of MAP of six groups in general anesthesia maintain was lower than the stable index of the basal MAP. There was no significant difference between the stab

关 键 词：儿童 瑞芬太尼 丙泊酚 全麻维持 量效关系 

分 类 号：R614.2[医药卫生—麻醉学]