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瑞芬太尼静脉连续输注在儿童和成人保留自主呼吸的剂量
The doses of remifentanil to maintain spontaneous ventilation in children and adults during total intraveneous anesthesia

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DOI:
作者:
姚峥 徐静 陈莲华
Yao Zheng, Xu jing, Chen Lianhua
作者单位:
上海交通大学附属第一人民医院
Department of Anesthesiology, First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
关键词:
瑞芬太尼 自主呼吸 儿童 成人 全凭静脉麻醉
remifentanil; spontaneous ventilation; children; adult; total intravenous anesthesia
摘要:
目的：观察瑞芬太尼复合异丙酚全凭静脉麻醉在儿童和成人维持自主呼吸的剂量。方法：41例行眼科手术的患者，根据年龄分为两组，组A：1岁~14岁患儿，组B：成人。采用静吸复合诱导，吸入8%七氟醚，5L/min，静注异丙酚3mg/kg、瑞芬太尼1.5μg/kg，置入喉罩，关闭七氟醚。持续静脉输注异丙酚200μg•kg-1•min-1和瑞芬太尼，调节瑞芬太尼输注速度至呼吸频率升至10次/min以上，即为瑞芬太尼呼吸恢复剂量。再上调瑞芬太尼输注速度至患者呼吸频率降至10次/min或以下，或者呼末二氧化碳高于65mmHg，即为瑞芬太尼呼吸抑制剂量。取瑞芬太尼呼吸恢复剂量和呼吸抑制剂量的算术均数为保留自主呼吸瑞芬太尼平均剂量。记录以上两个滴定终点时患者的心率、血压和呼末二氧化碳。结果： 41例患者麻醉效果均满意，顺利完成手术。保留自主呼吸瑞芬太尼平均剂量组A为0.13μg•kg-1•min-1，组B为0.08μg•kg-1•min-1，组A保留自主呼吸瑞芬太尼平均剂量显著高于组B（P<0.05）；结论：瑞芬太尼复合异丙酚全凭静脉麻醉时，瑞芬太尼维持自主呼吸的平均剂量儿童为0.13μg•kg-1•min-1，成人为0.08μg•kg-1•min-1，儿童耐受瑞芬太尼的剂量显著高于成人。
The aim was to examine the doses of remifentanil tolerated during spontaneous ventilation under anesthesia maintained with propofol and remifentanil infusion in children and adults. Methods: Forty-one patients scheduled for ophthalmologic operation were divided by age into two groups (group A: 1 year ~14 years, group B: older than 18 years). Anesthesia was induced with propofol 3mg/kg and remifentanil 1.5μg/kg in combination with sevoflurane inhalation, and then a laryngeal mask was iuserted. Propofol 200μg•kg-1•min-1 was continuously infused during maintenance of anesthesia. An infusion of remifentanil was started at 0.2μg•kg-1•min-1 and the infusion rate was adjusted until the patient was breathing spontaneously at a rate just greater than 10br/min. Once this endpoint was achieved, the infusion rate was recorded. Then the infusion rate was increased until the patient’s respiratory rate decreased to 10br/min or less and was recorded. The mean of the two infusion rates was defined as the dose of remifentanil to maintain spontaneous ventilation. Once the endpoint was achieved, heart rate, blood pressure and PETCO2 were recorded. Results: The doses of remifentanil to maintain spontaneous ventilation were 0.13μg•kg-1•min-1 and 0.08μg•kg-1•min-1 in the group A and group B respectively. The titrated rate of remifentanil tolerated in children was statistically significant higher than that in adults (P<0.05). Conclusions: Children tolerate a higher dose of remifentanil during spontaneous anesthesia than adults.

 

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