【摘要】 目的 確定在不同濃度七氟醚復合瑞芬太尼誘導無肌松氣管插管時瑞芬太尼的半數有效量（ED50）。 方法 2009年7月-2009年11月擇期手術患者60例，ASA I~II，年齡20~59歲，按照入室的順序隨機分為Ⅰ組（2%七氟醚組）和Ⅱ組（3%七氟醚組），預沖8%七氟醚誘導，眼瞼反射消失后，調節七氟醚呼氣末濃度分別維持在2%或3%，同時按照序貫法注入瑞芬太尼，瑞芬太尼注射90 s后氣管插管。記錄麻醉誘導前、患者意識消失時、插管前1 min、插管后1 min及插管后3 min心率、平均動脈壓的變化。 結果 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量（ED50）及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 結論 2%、3%的七氟醚復合瑞芬太尼誘導氣管插管時瑞芬太尼的半數有效量及其相對應的95%可信區間分別為0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
目的:比較七氟醚吸入麻醉和丙泊酚、瑞芬太尼靜脈麻醉用于小兒手術的臨床效果。方法:100例1～8歲的患兒隨機分為丙泊酚、瑞芬太尼組(A組)與七氟醚吸入組(B組）。麻醉誘導后,A組持續輸注丙泊酚和瑞芬太尼維持麻醉,B組吸入七氟醚維持麻醉。術中根據生命體征調整丙泊酚、瑞芬太尼的輸注速度及七氟醚的吸入濃度,記錄術中循環變化、術后麻醉恢復情況。結果:與B組相比,A組術中MAP下降明顯(Plt;005)。結論:與A組相比,B組術中生命體征控制平穩;術后清醒迅速、完全、平穩,拔管時間無明顯差異。
目的:觀察經喉罩全憑七氟醚吸入麻醉在小兒腹股溝疝手術中的臨床應用效果。方法：60例ASAⅠⅡ級擇期行腹股溝疝囊高位結扎術的患兒隨機分成喉罩七氟醚組（實驗組）和氯胺酮組（對照組）。實驗組以七氟醚誘導后置入喉罩，經喉罩全憑七氟醚吸入維持麻醉，對照組以氯胺酮和異丙酚誘導和維持麻醉。比較兩組血流動力學、呼氣末CO2分壓（PETCO2）、手術時間、蘇醒時間、出室時間（在恢復室內停留時間）。記錄術中和術后不良反應如體動反應、嗜睡、惡心嘔吐等發生情況。結果：對照組在T3、T4、T5時點HR、BP均明顯高于實驗組相應時點（Plt;0.05）。實驗組患兒蘇醒時間和出室時間均明顯低于對照組（Plt;0.05）。對照組體動反應和嗜睡發生率明顯高于實驗組（Plt;0.05）。實驗組術后惡心發生率明顯高于對照組（Plt;0.05）。結論：經喉罩全憑七氟醚吸入麻醉用于小兒腹股溝疝手術，術中經過更平穩，麻醉恢復更快，術中及術后不良反應少。
目的 研究七氟醚誘導氣管插管減輕短期內行兩次手術的腦性癱瘓患兒術前焦慮的效果。 方法 2009年12月－2011年7月選擇需要短期內行兩次全身麻醉（全麻）手術的痙攣性腦性癱瘓患兒60例，美國麻醉醫師協會（ASA）Ⅰ～Ⅱ級。隨機分為A組常規麻醉誘導氣管插管（30例）和B組七氟醚誘導氣管插管（30例）；分別在一期及二期手術術前訪視時（M1、M3）、入手術室時（M2、M4）對兩組患兒進行改良耶魯圍術期焦慮量表評估；并分別在一期及二期手術麻醉誘導期（N1、N2）對兩組患兒進行誘導期合作度量表的標準評定。 結果 同組一期、二期手術比較，A組患兒二期手術術前焦慮更明顯（P＜0.05），二期入手術室時焦慮更明顯（P＜0.05），二期手術合作度更差（P＜0.05）；B組患兒兩次手術術前焦慮無明顯變化（P＞0.05），一期入手術室時焦慮明顯（P＜0.05），一期手術合作度較差（P＜0.05）。兩組之間，一期手術兩組患兒焦慮情況無明顯區別（P＞0.05），二期手術A組比B組的患兒焦慮更明顯（P＜0.05），兩次手術B組都比A組的患兒合作度更好（P＜0.05）。 結論 七氟醚麻醉誘導氣管插管能夠有效減輕短期內需要進行兩次手術的痙攣性腦性癱瘓患兒的術前焦慮，提高患兒二期手術的合作度，提供良好的手術麻醉條件，保證患兒的圍術期安全。
摘要:目的:分析與比較七氟醚吸入麻醉和丙泊酚靜脈復合麻醉應用于三聚氰胺致嬰幼兒輸尿管結石手術的麻醉效果。方法:60例輸尿管結石患兒隨機分為七氟醚(Sev)組(n=30)和丙泊酚(Pro)組(n=30)。觀察并記錄誘導時間、氣管內插管時間、蘇醒時間、拔除氣管插管時間、PACU滯留時間。記錄麻醉誘導和蘇醒期的不良反應。另外記錄兩組病人誘導前、插管前、插管后3 min、5 min、15 min、30 min時點的血壓、心率、脈搏血氧飽和度(SPO2)。結果:七氟醚組誘導時間(63.2±6.9)s長于丙泊酚組(38.2±12.7)s,七氟醚組拔除氣管插管時間(11.9±4.7)min短于丙泊酚組(15.6±8.2)min,兩組相比有統計學意義(Plt;0.05)。七氟醚組躁動發生率53.3%顯著高于丙泊酚組13.3%(Plt;0.01)。七氟醚組在插管前、插管后各時點的血壓、心率與誘導前相比,差異無統計學意義(Pgt;0.05),丙泊酚組插管前、插管后3 min、5 min與誘導前相比血壓、心率顯著降低(Plt;0.05),與同時間點七氟醚組相比血壓顯著降低(Plt;0.05)。結論:兩種麻醉方法均可安全有效用于嬰幼兒輸尿管結石手術,七氟醚組血流動力學更平穩,但躁動發生率較高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
目的:觀察、比較七氟醚吸入麻醉與全憑靜脈麻醉在小兒先天性心臟病手術中的應用。方法: 40例擇期行先天性心臟病房室缺矯治術患兒,隨機分為七氟醚組和全憑靜脈麻醉組(TIVA組),每組各20例。七氟醚組患兒以七氟醚吸入誘導,復合小劑量芬太尼、咪達唑侖、維庫溴銨,麻醉維持為七氟醚吸入+芬太尼、維庫溴銨;靜脈組患兒肌注氯胺酮后,以芬太尼、咪達唑侖、維庫溴銨誘導,維持使用丙泊酚持續泵入+芬太尼、維庫溴銨。比較兩組術中各時點血流動力學變化、手術麻醉時間與芬太尼、維庫溴銨用量、術后呼吸支持時間、清醒時間、拔管時間,比較兩組不良反應發生情況。結果: 兩組患兒均維持比較穩定的血流動力學狀態。七氟醚組芬太尼與維庫溴銨用量明顯低于TIVA組,呼吸支持時間、清醒時間、拔管時間明顯低于TIVA組。七氟醚組2例術后發生躁動,3例發生惡心,稍高于TIVA組。結論: 七氟醚應用于小兒先心房室缺矯治術,可提供穩定的血流動力學狀態,并降低芬太尼與肌松劑用量,實現術后早拔管、改善患者預后、降低醫療費用。
目的:觀察七氟醚靶控用于低流量吸入麻醉維持的臨床規律及血流動力學變化,尋求靶控下的藥物量化指標。方法:選擇60例20～60歲手術患者,隨機分2組每組30例:P組(丙泊酚)常規實施全憑靜脈TCI靶控麻醉;S組(七氟醚),實施低流量七氟醚靶控吸入麻醉(BIS值40)。分別記錄誘導前(T1),插管后5(T2)、15(T3)、30(T4)45(T5)、60(T6)、90(T7)、120(T8)min時的、MBP、HR、;Sev組患者加記各個時點的七氟醚IT、ET的MAC值。結果:T2點兩組均比T1 降低(Plt;0.05),S 組高于P組(Plt;0.05),兩組比較T3至T7無顯著性差異(Pgt;0.05);S 組T3 至T7 各點ET值無統計學差異,ET%:2.46,約1.4 MAC。結論:(1)七氟醚誘導較靜脈麻醉誘導患者血流動力學穩定,(2)低流量七氟醚靶控吸入麻醉維持平穩,調控簡便,效果良好。
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.