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目的探讨不同剂量异丙酚复合瑞芬太尼对脑瘫患儿非肌松气管插管条件满意度的影响。方法选取择期全麻下行选择性外周神经部分切断术的痉挛性脑瘫患儿80例,随机分为Ⅰ组(异丙酚3mg/kg+瑞芬太尼3μg/kg)、Ⅱ组(异丙酚3mg/kg+瑞芬太尼4μg/kg)、Ⅲ组(异丙酚4mg/kg+瑞芬太尼3μg/kg)及Ⅳ组(异丙酚4mg/kg+瑞芬太尼4μg/kg)各20例。经开放的上肢静脉依序缓慢静脉推注相应剂量的异丙酚(20s)和瑞芬太尼(60s),于瑞芬太尼注射后60s用Macintosh直接喉镜行气管插管。观察气管插管条件的满意度。结果 4组均一次插管成功。Ⅰ组插管满意8例(40.0%)显著低于其他3组,Ⅳ组插管满意20例(100.0%)明显较其他3组高,差异有统计学意义(P<0.05)。Ⅱ组插管满意15例(75.0%)与Ⅲ组16例(80.0%)比较差异无统计学意义(P>0.05)。各组患儿插管前血压及心率均明显低于基础值,比较差异有统计学意义(P<0.05)。Ⅰ组插管后血压、心率明显高于插管前,比较差异有统计学意义(P<0.05);其他3组插管前、后血压及心率比较差异无统计学意义(P>0.05)。结论在未使用肌松药条件下,3mg/kg异丙酚复合4μg/kg瑞芬太尼和4mg/kg异丙酚复合3~4μg/kg瑞芬太尼能有效抑制气管插管前后引起的心血管反应且可获得满意的气管插管条件。
Objective To investigate the effects of different doses of propofol combined with remifentanil on satisfaction of non-muscle-tracheal intubation in children with cerebral palsy. Methods Eighty children with spastic cerebral palsy who underwent selective partial peripheral partial neurosurgery under general anesthesia were randomly divided into three groups: propofol 3mg / kg and remifentanil 3μg / kg, group Ⅱ (propofol 3mg / / kg + remifentanil 4μg / kg), group Ⅲ (propofol 4mg / kg + remifentanil 3μg / kg) and group Ⅳ (propofol 4mg / kg + remifentanil 4μg / kg) in 20 cases. Propofol (20s) and remifentanil (60s) were infused intravenously slowly through the open upper extremity vein, followed by tracheal intubation with Macintosh direct laryngoscope 60s after remifentanil injection. To observe the satisfaction of tracheal intubation conditions. Results The four groups were successfully intubated. The satisfaction rate of intubation in group Ⅰ was significantly lower than that of the other three groups (8%, 40.0%, 20%, 100%) in group Ⅳ. The difference was statistically significant (P <0.05). There were no significant differences between the two groups (P> 0.05) in 15 patients (75.0%) satisfied with intubation and 16 patients (80.0%) in group Ⅲ. The blood pressure and heart rate before intubation in each group were significantly lower than the baseline value, the difference was statistically significant (P <0.05). After intubation, the blood pressure and heart rate in group Ⅰ were significantly higher than those before intubation (P <0.05). There was no significant difference in blood pressure and heart rate between the other three groups before and after intubation (P> 0.05). Conclusion In the absence of muscle relaxants, 3mg / kg propofol 4μg / kg remifentanil and 4mg / kg propofol 3 ~ 4μg / kg remifentanil can effectively inhibit the before and after tracheal intubation caused Cardiovascular responses and satisfactory endotracheal conditions were obtained.