七氟醚复合笑气用于小儿麻醉诱导平稳气管插管最低肺泡有效浓度分析  

Analysis on minimum alveolar concentration of sevoflurane combined with nitrous oxide for smooth tracheal intubation under general anesthesia induction in children

作　　者：陈宏志[1] 王杰[1] CHEN Hong-zhi;WANG Jie(Department of Anesthesiology,Shengjing Hospital of China Medical University,Shen-yang 110004,China)

机构地区：[1]中国医科大学附属盛京医院麻醉科,沈阳110004

出　　处：《实用药物与临床》2018年第8期892-895,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探究七氟醚复合笑气用于小儿全凭吸入麻醉诱导插管时平稳气管插管的最低肺泡有效浓度(MAC_(EI))。方法选取年龄为1～3岁、ASAⅠ级、择期全麻下行麦粒肿切除术的患儿,随机分为七氟醚复合笑气吸入诱导组(SN组)和单纯七氟醚吸入诱导组(S组)。SN组麻醉诱导时采用8%七氟醚复合50%笑气与氧气的混合气体,S组采用8%七氟醚复合纯氧进行诱导。待患儿失去意识后,调节呼气末七氟醚浓度(C_(ET)S_(EV))至初始预定值,维持恒定浓度至少3 min,然后插入气管导管。根据Dixon's上下法进行实验,初始C_(ET)S_(EV)从2.0开始,相邻浓度梯度设为0.2%。插入气管导管时若发生体动反应,则下一例患儿插管时的C_(ET)S_(EV)升高1个浓度梯度;反之,若患儿未发生体动反应,则下一例患儿插管时的C_(ET)S_(EV)降低1个浓度梯度。计算每对无体动反应-体动反应的C_(ET)S_(EV)中点的平均值即MAC_(EI)值。结果 SN组MAC_(EI)值为2.07%(95%CI 1.52%～2.17%),S组MAC_(EI)值为2.26%(95%CI 1.10%～2.42%),差异有统计学意义(P=0.012)。SN组平稳气管插管的时间为(3.32±0.12)min,较S组(5.02±0.84)min缩短,差异有统计学意义(P=0.023)。结论采用七氟醚复合笑气用于小儿麻醉诱导可降低MAC_(EI)值,且能缩短插管时间。Objective To investigate the minimum alveolar concentration of smooth tracheal intubation （ MACE1 ） of sevoflurane and nitrous oxide which are used to conduct smooth tracheal intubation under general anesthesia induction in children. Methods Children,aged 1-3 years,ASA 1 ,undergoing elective hordeolum incision with inhalation general anesthesia were era＇oiled. They were randomly divided into sevoflurane ＋ nilrous oxide inhalation induction group （group SN） and sevoflurane inhalation induction group （group S ）. Anesthesia was induced with sevoflurane （8%） combined with nitrous oxide （50%） in group SN or oxygen in group S. After the child＇s consciousness disappeared, the concentration of sevoflurane was adjusted to the initial predetermined value for at least 3 rain,and then the lracheal ntbe was allempted quickly. The experimenl was conducted according to Dixon＇s method. The initial end-tidal concentration of sevoflurane （CETSEv） was begun at 2% and the concentration gradient was set to 0. 2%. If the body movement occurred when inserting the endotracheal tube,then CET SEv of next patient increased a concentration gradient;on the contrary,if the children did not occur in dynamic response,the CET SEv of next patient decreased a gradient. The midpoint from lhe body movement response to non-body movement response was set as lhe balance point and the mean value of the concentrations of sevoflurane at all the balance points were calculated as MACEI. Results The MACEi in group SN and group S was 2. 07% （95% CI 1.52% -2.17%） and 2. 26% （95% CI 1.10% 2.42% ） , there being significant difference between the two groups （P -0. 012 ）. The time of smooth tracheal intubation in group SN was （3.32 ±0. 12） min,which was shorter lhan that of group S[（5.02 ±0. 84） min]（P -0. 023）. Conclusion Sevoflurane combined with nitrous oxide can reduce the value of MACEI for the induction of anesthesia and shorten the intubation time.

关 键 词：七氟醚 笑气 小儿 气管插管 最低肺泡有效浓度 

分 类 号：R726.1[医药卫生—儿科]