依托咪酯復合舒芬太尼用于小兒喉罩放置的臨床觀察

1、依托咪酯復合舒芬太尼用于小兒喉罩放置的臨床觀察摘要目的探討依托咪酯復合舒芬太尼用于小兒喉罩放置的麻醉 效果。方法 選擇小兒患者60例，隨機均分為依托咪酯組(e組，n=30) 和丙泊酚組(p組，"30)。麻醉誘導時，兩組患者先緩慢注入舒芬太尼 0.3 u g/kg,隨后e組注入依托咪酯乳劑0. 3 mg/kg, p組注入丙泊酚2 mg/kg,采用反轉法放置喉罩。觀察患兒喉罩置入時反應，出現吞咽、嗆 咳、屏氣、喉痙攣等氣道反應或肢體運動，均認為喉罩置入體動反應陽性; 記錄麻醉誘導前、后1 min和喉罩置入后1 min患者的hr、sbp、dbp；記 錄每例患者成功放置喉罩的置入次數及肌陣攣

2、等不良反應發(fā)生的病例數。 結果 喉罩置入體動反應陽性例數：e組2例(6.7%), p組1例(3.3%), 兩組差異無統(tǒng)計學意義(p>0. 05)o e組喉罩放置首次成功28例(93. 3%), 兩次放置成功2例(6.7%), p組喉罩放置首次成功27例(90. 0%),兩次 放置成功3例(10. 0%),兩組差異無統(tǒng)計學意義(p>0. 05)o兩組麻醉誘 導后1 min和喉罩置入后1 min患者sbp、dbp與麻醉誘導前比較，e組略 有下降(p>0. 05), p組明顯降低(p<0. 01),兩組麻醉誘導后1 min和 喉罩置入后1 min相同時點比較，e組患者sbp、

3、dbp明顯高于p組(p< 0.01)o兩組均未發(fā)生肌陣攣。結論 依托咪酯復合0.3 ug/kg舒芬太尼 用于小兒全身麻醉誘導，血流動力學穩(wěn)定，能提供良好的喉罩放置條件。關鍵詞依托咪酯；舒芬太尼；喉罩；小兒 中圖分類號r614. 2+1 文獻標識碼a文章編號1674-4721 (2014)03 (c) -0085-03clinical observation of etomidate com bi ned with sufentanil for laryngeal mask airway insertion in chiidrenwen si-cheng mai wu-jun tang y

4、i-min chen qian-peidepartment of anesthesiology, people f s hospital of qingxin district in qingyuan city, guangdong province, qingyuan 511800, china abstract objective to explore the effect and safety of etomidate combined with sufentanil for laryngeal mask airway (lma) insertion in children. metho

5、ds 60 children undergoing operation were randomly divided into etomidate group (group e, n二30) and propofol group (group p,n二30). during induction sufentdn訂 (0.3 p g/kg) was injected slowly first, then 0.3 mg/kg etomidate or 2 mg/kg propofol was injected respectively in two groups. lma was inserted

6、by inversionmethod .allreactions such asswallowing, coughing, breath holding,laryngospasm and limb movements were defined as positive body reaction. the hr, sbp and dbp were recorded at 1 min before or after induction and after lma insertion. times for successful lma insertion and the adverse reacti

7、ons such as the number of cases of myoclonus were observed in all children. results there was no significant differenee forlma insertion body reaction between group e (2 cases, 6. 7%) and groupp 仃 case, 3. 3%)(p>0. 05). in group e, 28 patients (93. 3%) weresuccessfully inserted lma in the first t

8、ime, while 2 patients (6. 7%)did in the second time. in group p,27 patients (90.0%) were successfully inserted lma in the first time and 3 patients (10.0%)did in the second time .there was no significant difference for rate of success between two groups (p>0.05)sbp and dbp decreased slightly at 1

9、 min after anesthesia induction and 1 min after lma insertion in group e (p>0.05),while group p decreased signif ica ntly (p 0.01) .at 1 min after in duct! on and 1 min after lma insertion, sbp and dbp in group e were significantly higher than those in group p (p<0.01). there was no myoclonus

10、in two groups. conclusion etomidate combined with sufentanil (0.3 u g/kg) can provide a good condition for lma insertion with stable hemodynamics during induction.key wordsetomidate;sufentani1;laryngealmaskairway;children喉罩通氣可行自主或機械通氣，與其他通氣方式比較，誘發(fā)軀體、自 主神經激惹反應低1,目前國內外已廣泛用于小兒屮、小手術全身麻醉 的通氣管理。依托咪酯具有麻醉起效快、對循環(huán)和呼吸影響小等優(yōu)點，缺 點是麻醉誘導時出現肌陣攣，對腎上腺皮質功能有