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目的评价在不使用肌松药情况下不同剂量瑞芬太尼复合舒芬太尼减轻脑瘫小儿经口气管插管心血管反应的效果。方法 60例行择期手术脑瘫患儿,随机均分为3组,瑞芬太尼用量分别为2μg/kg组(R1组),4μg/kg组(R2组),6μg/kg组(R3组)。诱导给予丙泊酚(3 mg/kg)和舒芬太尼(0.3μg/kg)后分别静脉输注3个不同剂量的瑞芬太尼行气管插管,分别于麻醉诱导前,气管插管前即刻,插管后1 min、3 min记录平均动脉压和心率,并对插管条件进行评估。结果诱导后各组心率、血压均有下降,以R2和R3组尤其明显,平均动脉压显著下降则见于R3组;R1组患儿插管后与插管前即刻相比心率与血压明显升高。R1组气管插管条件满意率低于R2、R3组(70%vs.95%、100%,P<0.05),但R2、R3组间差异无统计学意义(P>0.05)。结论瑞芬太尼4μg/kg复合丙泊酚、舒芬太尼用于脑瘫小儿无肌松药直接喉镜经口气管插管时,麻醉诱导平稳、安全,可提供满意的气管插管条件。
Objective To evaluate the effect of different doses of remifentanil and sufentanil on the reduction of cardiovascular responses to orotracheal intubation in children with cerebral palsy without using muscle relaxants. Methods Sixty children with cerebral palsy undergoing elective surgery were randomly divided into three groups: remifentanil (2μg / kg, R1, 4μg / kg), 6μg / kg . Induction of propofol (3 mg / kg) and sufentanil (0.3 μg / kg) were intravenous infusion of three different doses of remifentanil tracheal intubation, respectively, before induction of anesthesia, endotracheal intubation Immediately before the intubation, mean arterial pressure and heart rate were recorded at 1 min and 3 min after intubation, and intubation conditions were evaluated. Results After induction, heart rate and blood pressure decreased in all groups, especially in R2 and R3 groups, mean arterial pressure decreased significantly in group R3; R1 group had significantly higher heart rate and blood pressure after intubation compared with before intubation . The satisfactory rate of endotracheal intubation in group R1 was lower than that in group R2 and R3 (70% vs 95%, 100%, P <0.05). However, there was no significant difference between group R2 and group R3 (P> 0.05). Conclusion Remifentanil 4μg / kg propofol combined with sufentanil is an effective and safe method for endotracheal intubation in children with cerebral palsy without muscle relaxant.