小儿择期手术使用不同剂量瑞芬太尼、丙泊酚诱导抑制气管插管反应效果比较  

Comparison of the effects of different doses of remifentanil and propofol on inhibition of response of tracheal intubation in elective surgery in children

作　　者：康力[1] 刘华[1] 陈丽[1] 吕东森[1] 袁承城[1] 刘焕结[1] KANG Li;LIU Hua;CHEN Li;LV Dongsen;YUAN Chengcheng;LIU Huanjie(Baoan District Hospital of Traditional Chinese Medicine,Shenzhen 518133,Guangdong,China)

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》2018年第28期3094-3097,共4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：目的观察接受择期手术的小儿实施不同剂量瑞芬太尼、丙泊酚静脉诱导抑制气管插管反应的效果,找出抑制气管插管反应效果最佳的瑞芬太尼、丙泊酚配伍用量。方法选择普外、骨科择期手术接受全麻的1~10岁小儿90例,随机分为4组,均在手术日之前的1~3 d测量小儿的基础血压、心率。诱导用药:A组(30例)泵注丙泊酚1. 5mg/kg、瑞芬太尼15μg/kg; B组(20例)泵注丙泊酚1. 5 mg/kg、瑞芬太尼20μg/kg; C组(20例)泵注丙泊酚2. 0 mg/kg、瑞芬太尼15μg/kg; D组(20例)泵注丙泊酚2. 0 mg/kg、瑞芬太尼20μg/kg。4组泵注时间均为6 min,泵注1 min时给予静注阿托品0. 008 mg/kg,意识消失以后再给予静注维库溴铵0. 12 mg/kg,泵注结束后立即测量血压、心率,然后进行气管插管。分别记录小儿基础、诱导后气管插管前、气管插管后(1~3 min)血压、心率。结果 D组插管前MAP比其基础MAP降低幅度大于A组、B组、C组(P均<0. 05),A、B、C组间MAP降低幅度比较差异无统计学意义(P均> 0. 05);插管后MAP比其插管前MAP升高幅度B组<C组<D组<A组,4组间比较差异无统计学意义(P均>0. 05),但B组MAP升高值还是比A组减少35. 24%。D组插管前HR比其基础HR升高,其他3组插管前HR均比其基础HR降低,但3组间降低幅度比较差异无统计学意义(P均> 0. 05); 4组插管后HR均比插管前HR升高,组间比较差异无统计学意义(P均> 0. 05),但B组HR升高值还是比A组减少39. 50%。抑制气管插管反应效果A组、B组均为Ⅰ级,C组、D组均为Ⅱ级。结论小儿使用丙泊酚1. 5 mg/kg和瑞芬太尼20μg/kg配伍进行全麻诱导抑制气管插管反应效果最为理想,整个诱导、插管过程中血流动力学更加平稳。Objective It is to observe the effect of different doses of remifentanil and propofol on the inhibition of response of tracheal intubation in children undergoing elective surgery, and to find the best compatibility of remifentanil and propofol in inhibiting response of endotracheal intubation. Methods A total of 90 children aged 1 to 10 years who underwent general anesthesia were enrolled and randomly divided into 4 groups. The basal blood pressure and heart rate of the children were measured 1 to 3 days before the operation day. Induction medication： group A （30 cases） pumped propofol 1.5 mg/kg, remifentanil 15 μg/kg; group B （20 cases） pumped propofol 1.5 mg/kg, remifentanil 20 μg / kg; group C （20 cases） pumped propofol 2.0 mg/kg, remifentanil 15 μg/kg; group D （20 cases） pumped propofol 2.0 mg/kg, remifentanil 20 μg/kg. The pumping time of all 4 groups was 6 min. When the pump was injected for 1 min, the intravenous atropine was given at 0.008 mg/kg. After the consciousness disappeared, the intravenous infusion of vecuronium 0.12 mg/kg was given. At the end of the pumping, the blood pressure and heart rate were measured immediately, and then endotracheal intubation was performed. The blood pressure and heart rate of the pediatric foundation, before the tracheal intubation, and after the tracheal intubation （1 to 3 min） were recorded. Results The reduction of MAP in group D was greater than that in group A, group B and group C （ P 〈0.05）, there was no significant difference in the decrease of MAP between groups A, group B and group C （ P 〉0.05）. The increase value of MAP between post-intubation and pre-intubation from low to high was group B〈group C〈group D〈group A, there was no significant difference among the four groups （ P 〉0.05）, but group B was still 35.24% less than the increase value of MAP in group A. The HR of the D group was higher than that of the basal HR before intubation. The HR of the other 3 groups was lower than the basal HR, but there was no

关 键 词：小儿全麻诱导 瑞芬太尼 丙泊酚 配伍剂量 气管插管反应 

分 类 号：R614.2[医药卫生—麻醉学]