靶控输注瑞芬太尼复合七氟醚诱导用于小儿气管插管

目的观察不同血浆浓度瑞芬太尼复合七氟醚诱导，对小儿不使用肌松药所提供的气管插管条件和心血管反应。方法60例择期气管插管全麻患儿，按不同血浆浓度瑞芬太尼随机分为3组，Ⅰ组2ng／ml，Ⅱ组3ng／ml，Ⅲ组4ng／ml。诱导使用8％七氟醚半紧闭吸入，待患儿入睡后开放静脉，维持2．5％七氟醚吸入5min后开始分别静脉靶控输注3个不同血浆浓度的瑞芬太尼，10min后气管插管。分别于麻醉诱导前（T0）、气管插管前即刻（T1）、插管后1min（T2）、3min（T3）记录平均动脉压（MAP）、心率（HR），并对插管条件进行评估。结果Ⅰ组气管插管条件满意率低于Ⅱ、Ⅲ组（P〈0．05），但Ⅱ、Ⅲ组差异无统计学意义（P〉0．05）；与T0时比较，各组患儿在T1时HR、MAP均明显下降（P〈0．05），Ⅲ组下降幅度最大（P〈0．01）；Ⅰ组在T2、T3时HR、MAP较T1明显升高（P〈0．05），且与Ⅱ、Ⅲ组比较，差异均有统计学意义（P〈0．05），但Ⅱ、Ⅲ组在T2、T3时HR、MAP与T1比较，差异均无统计学意义（P〉0．05）。结论瑞芬太尼3ng／ml复合2．5％七氟醚用于小儿无肌松药气管插管时，可提供满意的气管插管条件和稳定的血流动力学。

Different plasma concentrations of remifentanil combined with sevoflurane used to tracheal intubation in pediatric patients

Objective To observe the tracheal intubation conditions and hemodynamic changes during remifentanil target controlled infusion （TCI）at different plasma concentrations combined with 2. 5% sevoflurane. Methods Sixty pediatric patients were randomly allocated into three groups,remifentanil were given using TCI at plasma concentration of 2 ng/ml（ groupl ） ,3 ng/ml（ group 2） ,4 ng/ml（ group3 ） in each group respectively. Anesthsia was induced by sevoflurane inhalation at 8% , when the patients lost consciousness, maintained by 2. 5% sevoflurane inhalation for 5 rains, anesthesia were followed by remifentanil TCI. MAP and HR were recorded before induction, before intubation, and at 1 and 3 min after intubation, intubation conditions were evaluated. Results The satisfactory degree of intubation conditions in group 1 was significantly lower compared to that in group 2 and 3, but there was no significantly different between group 2 and 3. There was a significant reduction in MAP and HR before intubation compared to those before induction in all groups. Tracheal intubation was associated with an increase in group 1 than that in group 2 and 3. There was no significant difference in MAP and HR at 1 and 3 rain after intubation in group 2 and 3. Conclusion Remifentanil TCI with 3 ng/ml combined with 2. 5% sevoflurane without relaxants can provided clinically acceptable tracheal intubation conditions and stable hemodynamic.