早产儿平稳气管插管时七氟醚的最低肺泡有效浓度  

Minimum alveolar concentration of sevoflurane for endotracheal intubation without body movement in premature infants

作　　者：王强[1] 姚兰[1] 冯艺[1] 梁汉生[1] 

机构地区：[1]北京大学人民医院麻醉科,100044

出　　处：《临床麻醉学杂志》2016年第9期865-867,共3页Journal of Clinical Anesthesiology

摘　　要：目的：探讨早产儿气管插管无体动反应时的七氟醚最低肺泡有效浓度（MACEI ）。方法选择择期吸入全麻下行眼科手术的早产儿27例,矫正胎龄〈37周,ASA Ⅰ或Ⅱ级。吸入6%七氟醚进行全麻诱导,至患儿意识消失后,将呼气末七氟醚浓度调整至预定值,维持15 min,然后行气管插管。根据序贯法进行研究,初始呼气末七氟醚浓度为3.0%,如气管插管时发生体动反应,下一例升高一个浓度梯度,如气管插管时未发生体动反应,下一例降低一个浓度梯度,相邻浓度梯度为0.2%。将无体动反应时呼气末七氟醚浓度到体动反应时呼气末七氟醚浓度的中点设为一个平衡点,计算所有平衡点七氟醚浓度的平均值即为 MACEI 。结果患儿气管插管无体动反应的七氟醚MACEI 为2.55%±0.20%,MAC95是2.81%（95%CI 2.67%~3.58%）。结论早产儿平稳气管插管的七氟醚 MACEI 为2.55%,低于足月产儿的参考值。Objective To determine the minimum alveolar concentration for endotracheal intu-bation （MACEI ）of sevoflurane for curbing the responses to endotracheal intubation in 50% premature infants less than 37 weeks of corrected age.Methods Twenty-seven ASA Ⅰ or Ⅱ premature infants less than 37 weeks of corrected age were enrolled in this study.At first,the anesthesia induction was started by inhaling 6% sevoflurane.After the patient lost consciousness,the end tidal sevoflurane concentration （CET Sev）was adjusted to the target concentration and maintained stable for 1 5 min.En-dotracheal tube was then intubated.The up-and-down sequential method was used to calculate the MAC.The initial CET Sev was 3.0% and it was increased or decreased by 0.2% in the next patient ac-cording to the endotracheal intubation response.If the intubation response was positive,the CET Sev was increased;if the intubation response was negative,the CET Sev was decreased.The midpoint from negative response to positive response was set as a balance point and the mean value of the concentra-tions of sevoflurane at all the balance points were calculated as MACEI .Results The end tidal sevoflurane concentration for blunting the responses to endotracheal intubation in 50% premature in-fants was 2.55%±0.20%,and the MAC9 5 was 2.81% （95% confidence interval 2.67%-3.58%）. Conclusion The MACEI of sevoflurane for curbing the responses to endotracheal intubation in 50%premature infants less than 37 weeks of corrected age is 2.55%,which is lower than that in the full-term children.

关 键 词：早产儿 气管插管 七氟醚 最低肺泡有效浓度 

分 类 号：R726.1[医药卫生—儿科]