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瑞芬太尼对小儿七氟烷麻醉自主呼吸的影响

罗俊1,孙瑞强1,王永旺2,顾恩华1   

  1. 1. 天津市眼科医院
    2. 天津市第一中心医院
  • 收稿日期:2013-10-28 修回日期:2014-05-15 出版日期:2014-09-15 发布日期:2014-09-15
  • 通讯作者: 罗俊

The effects of remifentanil on spontaneous ventilation in children who received sevoflurane anesthesia

LUO Jun 1,RuiQiang Sun2, 3, 2   

  1. 1. Department of Anesthesiology, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Clinical College ofOphthalmology, Tianjin Medical University, Tianjin 300020, China
    2. 1 Department of Anesthesiology, Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Clinical College ofOphthalmology, Tianjin Medical University, Tianjin 300020, China;
    3. Department of Anesthesiology, Tianjin First Center Hospital
  • Received:2013-10-28 Revised:2014-05-15 Published:2014-09-15 Online:2014-09-15
  • Contact: LUO Jun

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摘要： 目的 研究不同剂量瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸的影响。方法 选择3～6岁七氟烷麻醉下斜视手术患儿120例，根据术中给予瑞芬太尼的剂量，将患儿随机分为四组（n=30）:C组（生理盐水）、L组（瑞芬太尼0.03μg?kg-1?min-1）,M组（瑞芬太尼0.06μg?kg-1?min-1）和H组（瑞芬太尼0.09μg?kg-1?min-1），每组30例。观察记录喉罩置入后（T1）、静注负荷量后（T2）、持续输注10min（T3）、持续输注15min（T4）、拔出喉罩（T5）时患儿呼吸频率（RR）、潮气量（VT）、分钟通气量（MV）、呼末CO2浓度（PETCO2）、呼末七氟烷浓度(PETSev)以及平均动脉压（MBP）、心率（HR）等循环指标，记录手术、麻醉、苏醒时间和术中不良反应情况。结果 四组患儿的基本情况和循环指标无统计学差异，四组患儿术中均无体动和低氧血症的发生。H组T3、T4时点RR和MV明显低于其他三组（P<0.05），PETCO2则高于其他三组；M组与L组RR和MV比较无统计学差异，但均显著低于C组（P<0.05）；四组VT比较无统计学差异。结论 0.03～0.09μg?kg-1?min-1瑞芬太尼持续输注对小儿七氟烷麻醉下自主呼吸具有抑制作用，但不会造成低氧血症的发生。呼吸抑制作用主要表现为患儿RR的降低，0.09μg?kg-1?min-1剂量抑制作用最明显，0.03～0.06μg?kg-1?min-1剂量间差异不显著。根据手术需要，选择中低剂量瑞芬太尼持续输注，既可保留患儿自主呼吸，又可减少对呼吸的抑制作用。

关键词: 瑞芬太尼, 七氟烷, 自主呼吸, 麻醉, 小儿

Abstract: Objective To investigate the effects of different infusion rate of remifentanil infusion on spontaneous ventilation in children who received sevoflurane anesthesia. Methods: A total of 120 children ,aged 3-6 years,undergoing strabismus surgery were assigned to 4 groups at random(n=30):C group(administration of saline),L group(remifentanil 0.03μg?kg-1?min-1), M group(remifentanil 0.06μg?kg-1?min-1) and H group(remifentanil 0.09μg?kg-1?min-1).The mean blood pressure,heart rates and respiratory rates,tidal volime,minute ventilation,and endtidal CO2, endtidal SEV were recorded after laryngeal mask insertion(T1), an initial bolus dose of remifentanil(T2),10mins after remifentanil infusion(T3),15mins after remifentanil infusion(T4), laryngeal mask remove(T5) respectively.The adverse events and time of induction,maintainance and emergence were also recoded. Results: There was no significant difference in general description , MBP, HR and VT in four groups.There was no body movement and desaturation observed. The RR and MV of H group at T3 and T4 were lower than other groups significantly(P<0.05) while PETCO2 were higher. The RR and MV between M and L group were not significantly different but lower than that of C group. Conclusions: Remifentanil infusion at a rate of 0.03～0.09μg?kg-1?min-1 could depress spontaneous ventilation in children who received sevoflurane anesthesia,but rarely lead to desaturaton.The respiratory depression effect is mainly manifested by reduction of RR rather than MV,especially at the rate of 0.09μg?kg-1?min-1..It is a good option to choose the low or moderate dose of remifentanil infusion to keep spontaneous ventilation in children while avoiding severe respiratory depression according to the demand of operations.

Key words: remifentanil, Sevoflurane, Spontaneous ventilation, Anesthesia, Pediatric