预先注射瑞芬太尼预防小儿静注罗库溴铵时的回避反应(1)
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【摘要】目的：评估在儿童患者中预先注射瑞芬太尼预防静注罗库溴铵时的回避反应的效能。方法：选择40例施行全麻的择期手术患者，年龄在3-10岁，ASAⅠ-Ⅱ级,患儿随机分为两组：瑞芬组，静注瑞芬1ug/kg，(20例患儿)；盐水组，静注盐水5ml(20例患儿)。用5mg/kg的硫喷妥钠进行麻醉诱导，患者意识丧失并且停止呼吸后10秒，注射实验药物，注射时间超过30秒，实验药物注射后1分钟以后，1%的罗库溴铵0.6mg/kg静注，注射时间超过5秒钟。结果：总的回避反应发生率在盐水组(19人，95%)明显高于瑞芬组(5人，25%)，在瑞芬组没有患者出现全身反应，而在盐水组全身反应的发生率为55%。瑞芬太尼还能防止在插管过程中平均动脉压的升高。讨论：这个实验表明了在儿童患者中预先注射1ug/kg瑞芬对减少注射罗库溴铵时的回避的发生一个安全简单的方法，并且提供了一个稳定的血液动力学环境。
【关键词】小儿；瑞芬太尼；罗库溴铵
【中图分类号】R614【文献标识码】A【文章编号】1008-6455(2011)04-0064-02
Pretreatment with remifentanil to prevent withdrawal after rocuronium in children
Liu Yongliang Liu Li Zhou Xuan
【Abstract】Objective:This study was designed to evaluate the efficacy of pretreatment with i.v. remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients. Methods:After obtaining parental consents, 40 paediatric patients were randomly allocated into two groups to receive either i.v. remifentanil 1 mg/kg(remifentanil group, n20) or i.v. saline 5 ml (saline group, n20). Anaesthesia was induced with thiopental sodium 2.5% (5 mg/ kg) and the test drug was injected over 30 s. One minute after the test drug injection, rocuronium 1%(0.6 mg/ kg) was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate were recorded on arrival in the operating theatre, before and 1 min after thetracheal intubation . Results:The overall incidence of withdrawal movements was significantly higher in the saline group (19 patients; 95%) than that in the remifentanil group (5 patients; 25%) (P<0.001).No patient in the remifentanil group showed generalized movement, whereas 55% of patients in the saline group did. Remifentanil prevented significant increase in MAP after intubation. Conclusion:This study demonstrated that pretreatment with remifentanil 1 ug/kg provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children.
【Key words】paediatric; remifentanil; rocuronium
静注罗库溴铵引起疼痛是罗库溴铵常见的副作用，有报道称这种疼痛可在50-80%的患者中出现[1-3]，在麻醉诱导过程中患者意识丧失后，静注罗库溴铵时可因注射部位疼痛产生的回避反应。因此建议用许多药物如芬太尼，利多卡因进行预处理来减少静注罗库溴铵产生疼痛引起的回避反应的发生 ......
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