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目的分析研究不同瑞芬太尼泵注速度对上肢骨折手术患儿的影响,为小儿临床应用瑞芬太尼提供依据。方法选择46例3～10岁上肢骨折患儿,面罩吸氧,未行气管内插管,手术开始前泵注瑞芬太尼,泵注速度从0.1μg/(kg·min)开始,之后每间隔5min增加0.025μg/(kg·min),直至出现呼吸抑制。观察不同瑞芬太尼泵注速度时患儿的心率、呼吸、脉搏、血氧饱和度、血压、呼气末二氧化碳和体动情况。结果所有患儿手术经过顺利。瑞芬太尼抑制患儿呼吸泵注速度为:0.175μg/(kg·min)时13例,0.2μg/(kg·min)时28例,0.225μg/(kg·min)时5例。停药和加压面罩给氧后所有患儿呼吸恢复,术后患儿无呼吸抑制、恶心呕吐、躁动和苏醒延迟等并发症发生。结论小儿上肢骨折手术可采用瑞芬太尼联合臂丛神经阻滞麻醉,小儿泵注瑞芬太尼的速度<0.18μg/(kg·min)为宜。
Objective To analyze the influence of different remifentanil pump speed on children with upper extremity fracture surgery and provide the basis for the clinical application of remifentanil in children. Methods Forty-six children aged 3 to 10 years with upper extremity fracture were enrolled in the study. Oxygen was applied to the mask and endotracheal intubation was performed. Remifentanil was injected before the start of the operation, and the pump speed was increased from 0.1μg / (kg · min) Interval 5min increase 0.025μg / (kg · min) until respiratory depression occurs. To observe the heart rate, respiration, pulse, oxygen saturation, blood pressure, end-tidal carbon dioxide and physical activity of children with different remifentanil pump speed. Results All patients underwent surgery successfully. Remifentanil inhibited 13 cases when breathing speed was 0.175μg / (kg · min), 28 cases was 0.2μg / (kg · min) and 5 cases was 0.225μg / (kg · min). Resuscitation and pressure masks to oxygen after resumption of breathing in all children without postoperative respiratory depression, nausea and vomiting, restlessness and wake delay and other complications. Conclusion Remifentanil combined with brachial plexus block anesthesia in children with upper extremity fracture surgery is recommended. The rate of remifentanil injection in children is less than 0.18μg / (kg · min).