右美托咪定与瑞芬太尼复合七氟醚-N2O麻醉诱导时患儿气管插管条件的比较  

Comparison of intubating conditions between dexmedetomidine and remifentanil when combined with sevoflurane-nitrous oxide for anesthesia induction in pediatric patients

作　　者：魏灵欣[1] 邓晓明[1] 夏伟鹏[1] 徐瑾[1] 王磊[1] 郅娟 温超[1] 王烨[1] 刘具会[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,100144

出　　处：《中华麻醉学杂志》2017年第6期711-714,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较右美托咪定与瑞芬太尼复合七氟醚-氧化亚氮（N2O）麻醉诱导时患儿的气管插管条件。方法择期整形外科手术患儿122例，年龄4～10岁，ASA分级I级，采用计算机随机抽样表格分为2组（n=61）：右美托咪定组（D组）和瑞芬太尼组（R组）。吸入8％七氟醚-60％N2O，新鲜气流量设定为6L／min，睫毛反射消失后D组和R组分别经50～60S静脉注射右美托咪定1μg／kg和瑞芬太尼1μg／kg，1min后行气管插管术。进行气管插管条件分级，记录气管插管条件满意和气管插管成功情况；记录气管插管前后心血管不良反应、低氧血症、喉痉挛和术后咽痛等并发症的发生情况。结果与D组比较，R组气管插管成功率、气管插管满意率、气管插管条件分级和术后咽痛发生率比较差异无统计学意义（P〉0．05），气管插管后高血压和窦性心动过速发生率升高（P〈0．05）。2组均未见低氧血症、喉痉挛、窦性心动过缓发生。结论吸入8％七氟醚-60％N2O麻醉诱导时，复合右美托咪定1μg／kg改善患儿气管插管条件的临床效果优于复合瑞芬太尼1μg／kg。Objective To compare the intubating conditions between dexmedetomidine and rcmifentanil when combined with sevofluranenitrous oxide （N20） for anesthesia induction in the pediatric patients. Methods A total of 122 pediatric patients, aged 4-10 yr, of American Society of Anesthesiolo- gists physical status I , undergoing elective plastic surgery, were randomly divided into dexmedetomidine group （group D, n= 61） and remifentanil group （group R, n = 61）. Eight percent sevoflurane and 60% N20 were inhaled for induction of anesthesia, and the fresh gas flow was set at 6 L/min. After disappear- ance of eyelash reflex, dexmedetomidine 1 μg/kg and remifentanil 1μg/kg were intravenously injected over 50-60 s in D and R groups, respectively, and 1 min later tracheal intubation was performed. The intuba- ting conditions were graded, and the satisfactory intubating conditions and successful intubation were recor- ded. The development of adverse cardiovascular reactions and complications such as hyoxemia and laryngo- spasm before and after intubation and postoperative pharyngodynia was recorded. Results Compared with group D, no significant change was found in the success rate of intubation, rate of satisfactory intubation, intubating condition grade or incidence of postoperative pharyngodynia （P〉0. 05） , and the incidence of hypertension and sinus tachycardia after intubation was significantly increased in group R （P〈0.05）. No pediatric patients developed hyoxemia, laryngospasm or sinus tachycardia in two groups. Conclusion When 8% sevoflurane and 60% N2O are inhaled for anesthesia induction, combing with dexmedetomidine 1 I^g/kg produces better clinical efficacy than t：ombing with remitentanil 1 μg/kg in improving the intubafing conditions for pediatric patients.

关 键 词：右美托眯啶 哌啶类 麻醉药 吸入 插管法 气管内 儿童 

分 类 号：R726.1[医药卫生—儿科]