不同速率输注瑞芬太尼对小儿下肢手术中止血带反应的影响  

Effect of remifentanil infusion rate on stress response in pediatric lower extremity surgery using a tourniquet application

作　　者：赵佳佳 李晓强 孙豹 王珊珊 张科学 Zhao Jiajia;Li Xiaoqiang;Sun Bao;Wang Shanshan;Zhang Kexue(Department of Pediatric Surgery,The Hospital of Shunyi District Beijing,Beijing,101300,China;Department of Endocrinology,the First Medical Center,Chinese PLA General Hospital,Beijing,100853,China)

机构地区：[1]北京顺义区医院麻醉科,北京101300 [2]中国人民解放军总医院第一医学中心小儿外科,北京100853

出　　处：《当代医学》2020年第19期32-34,共3页Contemporary Medicine

摘　　要：目的探讨不同速率输注瑞芬太尼对小儿下肢手术中止血带反应的影响。方法选择2017年10月至2019年10月本院收治的全身麻醉下行小儿下肢手术患者60例,ASAⅠ级,根据术中瑞芬太尼不同输注速率随机分为A组、B组与C组,各20例。A组:0.25μg/(kg·min);B组:0.5μg/(kg·min);C组:1.0μg/(kg·min)。分别于开始麻醉前(T0)、上止血带即刻(T1)、上止血带后10 min(T2)、上止血带后30 min(T3)、上止血带后45 min(T4)记录患者各时间点的MAP、HR、RPP、Glu、Tc、EtCO2。结果与A组比较,C组T3、T4时MAP、HR、RPP、Glu均明显降低(P<0.05);与B组比较,C组T3、T4时MAP、RPP明显降低,HR于T4时明显减慢(P<0.05);与T0比较,A组T3、T4时MAP、HR、RPP、Glu明显升高(P<0.05)。B组T3时MAP、RPP、Glu明显升高,T4时MAP、HR、RPP、Glu均明显升高(P<0.05)。结论瑞芬太尼可有效抑制小儿止血带引起的血流动力学反应,降低心肌氧耗,并具有一定的剂量依赖性,同时可缓解应激反应引起的血糖升高。Objective To investigate the effect of different rates of remifentanil infusion on tourniquet response in pediatric lower extremity surgery.Methods Thirty pediatric patients(ASA I)scheduled for lower extremity surgery were randomly divided into Group A,Group B and Group C,with 20 cases in each group,and each group was seperately infused remifentanil with the rate at 0.25μg/(kg•min)(Group A),0.5μg/(kg•min)(Group B),1.0μg/(kg•min)(Group C).MAP,HR,RPP,Glu,Tc,EtCO2 were recorded at following time:before anesthesia(T0),immediately(T1)and 10 min(T2),30 min(T3),45 min(T4)after the initiation of tourniquet application,respectively.Results Compared with group A,MAP,HR,RPP and Glu in group C at T3 and T4 were significantly reduced(P<0.05).Compared with group B,MAP and RPP in group C at T3 and T4 were significantly reduced,and HR was significantly reduced at T4(P<0.05).Compared with T0,MAP,HR,RPP and Glu in T3 and T4 of group A were significantly increased(P<0.05).MAP,RPP,Glu in group B were significantly increased at T3,and MAP,HR,RPP,Glu in T4(P<0.05).Conclusion Remifentanil can effectively inhibit the hemodynamic response caused by pediatric tourniquets and reduce myocardial oxygen consumption with a certain dose-dependence.At the same time,it can reduce the increase of blood glucose caused by the stress response.

关 键 词：瑞芬太尼 小儿 下肢手术 止血带 

分 类 号：R726.1[医药卫生—儿科]