本文選題：舒芬太尼　切入點(diǎn)：咪達(dá)唑侖　出處：《東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年02期

【摘要】：目的:研究舒芬太尼復(fù)合咪達(dá)唑侖和異丙酚用于小兒無肌松藥氣管插管的臨床價(jià)值。方法:將我院93例短小手術(shù)無肌松藥氣管插管患兒抽簽隨機(jī)分為A、B、C 3組,每組31例,均行舒芬太尼加咪達(dá)唑侖加異丙酚誘導(dǎo)麻醉,舒芬太尼分別給予0.3、0.4、0.5μg·kg~(-1)3種劑量,以Viby-Mogensen評分評價(jià)3組氣管插管情況并記錄成功率,同時(shí)記錄基礎(chǔ)值、麻醉誘導(dǎo)后(T0)、氣管插管即刻(T1)、氣管插管后1 min(T2)、氣管插管后3 min(T3)、氣管插管后5 min(T4)時(shí)心率(HR)、收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MAP)變化,分組記錄術(shù)后2、4、8、12、24 h鎮(zhèn)靜評分及疼痛評分,同時(shí)觀察不良反應(yīng)發(fā)生率。結(jié)果:3組均全部完成插管,插管成功率100%。C組氣管插管效果較好,但各組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);3組患兒于氣管插管即刻均見HR、MAP、DBP、SBP增高,與其他時(shí)間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí)點(diǎn)各水平呈C→B→A組遞增趨勢;術(shù)后疼痛程度以C組最輕,但3組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),3組術(shù)后Ramsay評分比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);3組不良反應(yīng)發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:舒芬太尼復(fù)合咪達(dá)唑侖和異丙酚可滿足小兒無肌松藥氣管插管的麻醉要求,舒芬太尼劑量與氣管插管時(shí)心血管反應(yīng)呈劑量依賴性,舒芬太尼0.4μg·kg~(-1)劑量可良好抑制不良應(yīng)激,保證氣管插管效果,并無明顯不良反應(yīng)出現(xiàn),可作為優(yōu)選方案。
[Abstract]:Objective: to study the clinical value of sufentanil combined with midazolam and propofol for tracheal intubation in children without muscle relaxant.Methods: 93 children with tracheal intubation without muscle relaxant in our hospital were randomly divided into three groups: group C (n = 31). Sufentanil plus midazolam plus propofol was used to induce anesthesia. Sufentanil was given 0. 3 渭 g / 0. 4 渭 g / g of sufentanil.The tracheal intubation was evaluated with Viby-Mogensen score and the success rate was recorded.After anesthesia induction, T0, T1, T2, T3, T3, T4, SBP, DBP, MAPP were observed. The scores of sedation and pain were recorded at 24 hours after intubation.At the same time, the incidence of adverse reactions was observed.Results the intubation was completed in all of the three groups. The intubation success rate in group 100 was better than that in group C, but there was no significant difference among the three groups (P 0.05). The DBPSBP of HRP MAPP was increased immediately after tracheal intubation.Compared with other time, the difference was statistically significant (P 0.05). At the same time, there was an increasing trend of each level in group C, and the degree of postoperative pain in group C was the least.However, there was no significant difference in Ramsay scores among the three groups. There was no significant difference in the incidence of adverse reactions among the three groups. There was no significant difference in the incidence of adverse reactions in the three groups.Conclusion: sufentanil combined with midazolam and propofol can meet the anesthesia requirements of tracheal intubation without muscle relaxant in children. The dose of sufentanil is in a dose-dependent manner with cardiovascular response to tracheal intubation. Sufentanil (0.4 渭 g 路kg ~ (-1)) can well inhibit adverse stress.To ensure the tracheal intubation effect, there is no obvious adverse reaction, which can be used as the optimal scheme.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院麻醉科;上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院麻醉科;
【基金】：國家自然科學(xué)基金青年科學(xué)基金項(xiàng)目(30901410)
【分類號】：R726.1

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