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| 舒芬太尼复合咪达唑仑和异丙酚用于小儿无肌松药气管插管的研究 |
| 作者：肖广莉1 张灵犀1 沈伯雄1 罗艳2 |
| 单位：1. 上海交通大学医学院附属第九人民医院 麻醉科, 上海 201999; 2. 上海交通大学医学院附属瑞金医院 麻醉科, 上海 201999 |
| 关键词：舒芬太尼 咪达唑仑 异丙酚 气管插管 |
| 分类号：R614 |
| 出版年·卷·期（页码）：2017·36·第二期（166-170） |
| 摘要： |
目的：研究舒芬太尼复合咪达唑仑和异丙酚用于小儿无肌松药气管插管的临床价值。方法：将我院93例短小手术无肌松药气管插管患儿抽签随机分为A、B、C 3组，每组31例，均行舒芬太尼加咪达唑仑加异丙酚诱导麻醉，舒芬太尼分别给予0.3、0.4、0.5 μg·kg-13种剂量，以Viby-Mogensen评分评价3组气管插管情况并记录成功率，同时记录基础值、麻醉诱导后（T0）、气管插管即刻（T1）、气管插管后1 min（T2）、气管插管后3 min（T3）、气管插管后5 min（T4）时心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）变化，分组记录术后2、4、8、12、24 h镇静评分及疼痛评分，同时观察不良反应发生率。结果：3组均全部完成插管，插管成功率100%。C组气管插管效果较好，但各组比较差异无统计学意义（P＞0.05）；3组患儿于气管插管即刻均见HR、MAP、DBP、SBP增高，与其他时间比较差异有统计学意义（P＜0.05），同时点各水平呈C→B→A组递增趋势；术后疼痛程度以C组最轻，但3组组间比较差异无统计学意义（P＞0.05），3组术后Ramsay评分比较差异均无统计学意义（P＞0.05）；3组不良反应发生率比较差异无统计学意义（P＞0.05）。结论：舒芬太尼复合咪达唑仑和异丙酚可满足小儿无肌松药气管插管的麻醉要求，舒芬太尼剂量与气管插管时心血管反应呈剂量依赖性，舒芬太尼0.4 μg·kg-1剂量可良好抑制不良应激，保证气管插管效果，并无明显不良反应出现，可作为优选方案。 |
Objective: To study the clinical value of sufentanil combined with midazolam and propofol applied in tracheal intubation without muscle relaxants for children. Methods: A total of 93 children who underwent short operation and tracheal intubation without muscle relaxants were randomized into group A, group B and group C, 31 cases in each group. All groups were treated with sufentanil combined with midazolam and propofol induced anesthesia, and the doses of sufentanil were 0.3, 0.4 and 0.5 μg·kg-1 respectively. The Viby-Mogensen score was used to evaluate the status of tracheal intubation and the success rate was recorded. The basic value, changes of heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial pressure(MAP) after induction of anesthesia(T0), immediately after intubation(T1), 1 min after intubation(T2), 3 min after intubation(T3) and 5 min after intubation(T4) were recorded. At postoperative 2, 4, 8, 12 and 24 h, the sedation scores and pain scores in all groups were recorded respectively. The incidence rates of adverse reactions were observed. Results: All groups completed intubation, and the success rate was 100%. The effect of tracheal intubation was better in group C, but there were no significant differences between groups(P>0.05); HR, MAP, DBP and SBP were increased abnormally in the three groups at the time of tracheal intubation. Compared with other time points, there were significant differences(P<0.05). Meanwhile, all levels showed C→B→A increasing trend. The degree of postoperative pain in group C was the lightest but there were no significant differences between the groups(P>0.05). There were no significant differences in postoperative Ramsay scores and the incidence of adverse reactions between the groups(P>0.05). Conclusion: Sufentanil combined midazolam and propofol can meet the anesthesia requirement of tracheal intubation without muscle relaxants in children. The doses of sufentanil with cardiovascular responses when performing tracheal intubation are dose-dependent. 0.04 μg·kg-1 sufentanil can well inhibit adverse stress, so as to ensure the effect of tracheal intubation. There are no significant adverse reactions. |
| 参考文献： |
[1] 仲山,尹宁,张锡凤,等.米库氯胺在婴幼儿手术麻醉中的肌松效应与安全性 [J].中国医药导刊,2014,16(10):1322-1323. |
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