摘要
目的探讨不同剂量芬太尼、丙泊酚及经环甲膜穿刺气管内表面麻醉,对全身麻醉患者行视可尼可视喉镜辅助快速诱导气管内插管反应的影响。方法选择60例ASAⅠ～Ⅱ级患者,随机分为3组,每组20例。麻醉诱导时除静脉注射咪达唑仑1～2mg、氟哌利多1～2mg/kg及罗库溴铵0.5mg/kg以外,Ⅰ组患者静脉注射芬太尼2μg/kg、丙泊酚1.5mg/kg,Ⅱ组患者静脉注射芬太尼3μg/kg、丙泊酚1.5mg/kg,Ⅲ组患者静脉注射芬太尼2μg/kg、丙泊酚1mg/kg。Ⅲ组患者在给予罗库溴铵和丙泊酚之前,经环甲膜穿刺并注射2%丁卡因2ml进行气管表面麻醉。3组患者均进行BIS监测,在BIS达最低值时,行视可尼可视喉镜辅助气管内插管。记录患者进入手术室后平静时(T0)、麻醉诱导后(T1)、插管后即刻(T2)、插管后5min(T3)无创血压、心率及BIS值的变化,以及拔管时患者呛咳评分、术后24h随访患者对环甲膜穿刺及气管插管等操作的不良记忆情况。结果各组患者麻醉诱导后血压、心率及BIS值均显著下降,其中Ⅱ组BIS下降最显著,明显低于Ⅲ组(P<0.05)。插管后即刻Ⅰ、Ⅱ组血压、心率均明显升高,明显高于Ⅲ组(P<0.05);Ⅰ、Ⅱ组血压变化相似(P>0.05),与入室后平静时相当,但Ⅰ组心率升高明显高于Ⅱ组(P<0.05)。拔管时,Ⅰ、Ⅱ组呛咳反应评分明显高于Ⅲ组(0.85±0.75、0.75±0.79vs.0.14±0.45,P<0.01)。术后3组患者对麻醉诱导期的环甲膜穿刺及气管插管等操作均无记忆。结论在咪达唑仑和氟哌利多辅助镇静的基础上,芬太尼2～3μg/kg、丙泊酚1.5mg/kg快速诱导麻醉即可较好抑制视可尼可视喉镜辅助气管内插管反应;若进行气管内表面麻醉则丙泊酚可降至1mg/kg,同时气管插管时心血管反应更轻微。
Objective To observe the response of endo -tracheal intubation under general anesthesia with the Shikani optical stylet induced by different dosage of fentanil and propofol or with endotracheal topical anesthesia through thyrocricoid puncture. Methods 60 patients with ASA Ⅰ～Ⅱ, aged from 20 to 65years, were divided into 3 groups （20 patients each）. Besides midazolam 1～2mg, droperidol 1～2mg, and rocuronium 0.5mg/kg, the drugs for induction included fentanyl 2μg/kg and propofol 1.5mg/kg i.v. for group Ⅰ,fentanyl 3μg/kg and propofol 1.5mg/kg i.v. for group Ⅱ, as well as fentanyl 2μg/kg and propofol 1mg/kg i.v. for group Ⅲ. The endotracheal topical anesthesia was performed only in group Ⅲ with 2% dicaine 2ml through thyrocricoid puncture before rocuronium and propofol i.v. All the patients were monitored by the BIS, and intubation were performed with Shikani optical stylet when the BIS reached to the lowest. The BP, ECG, SPO2, PETCO2, BIS were continuously monitored and the cough reaction during extubation was scored. The bad memory events such as performances of intubation and thyrocricoid puncture were recorded 24h after operation. Results The BP, HR and BIS value dramatically dropped after induction in all patients. The BIS value in group Ⅱwas lower than that in group Ⅲ （P 〈 0.05） . The BP, HR of patients in group ⅠandⅡ increased significantly after intubation, and were higher than that in group Ⅲ （P 〈 0.05）. The BP changes of group ⅠandⅡ were comparable, but the HR of group Ⅰwas faster than group Ⅱ （P 〈 0.05）. Cough during extubation happened in all three groups, but the score in group ⅠandⅡ were higher than that in group Ⅲ obviously （P 〈 0.05）. There was no uncomfortable memory in all three group patients. Conclusions With the sedation of midazolam and droperidol, fentanyl 2～3μg/kg and propofol 1.5mg/kg can inhibit the intubation response reasonably during tachy -induction endotracheal intubation with the Shikani optical stylet. If endotr
出处
《北京医学》
CAS
2009年第10期605-608,共4页
Beijing Medical Journal
关键词
气管插管
视可尼可视喉镜
气道反应
Endo-tracheal intubation Shikani opitcal stylet Intubation response
