摘要
目的探讨咪达唑仑复合芬太尼在纤维支气管镜引导气管插管中的应用的安全性和有效性。方法术前综合评估为困难气道,拟在气管插管全麻下手术的患者28例。随机分为对照组和观察组两组,每组14例。对照组患者只进行环甲膜穿刺+利舒卡喷雾表麻,观察组在局部麻醉基础上静脉注射咪达唑仑0.05 mg/kg,芬太尼2μg/kg。监测两组麻醉前(T0)、FOB进入咽腔时(T1)、进入声门时(T2)、插入气管导管时(T3)的MAP、HR、SpO2;记录插管过程中有无呛咳、恶心、躁动等插管反应,插管过程中SpO2<90%并中断操作,需面罩供氧定义为呼吸抑制;术后随访患者对插管过程的知晓程度(能够回忆完全或大部分插管过程定义为插管知晓)并做满意度调查。结果观察组麻醉效果优、良例数(9+4)例,可、差例数(1+0)例,对照组麻醉效果优、良例数(0+4)例,可、差例数(6+4)例。经2χ检验,0.025<P<0.05,差异有统计学意义。表明局麻基础上应用咪达唑仑复合芬太尼组麻醉效果优于单纯局麻组。对照组与T0比较,T1、T2、T3时MAP和HR明显升高(P<0.05),观察组与T0比较,T2、T3时MAP和HR明显升高(P<0.05),组间比较,观察组在各时间点MAP及HR均较对照组降低(P<0.05);观察组与T0比较,T1时SpO2有明显下降,与对照组同期相比也有明显下降(P<0.05)。与对照组比较,观察组患者的插管反应、插管知晓发生率明显降低(P<0.01),术后随访患者观察组有11例表示满意或者非常满意。结论在环甲膜穿刺+表面黏膜麻醉基础上静脉注射咪达唑仑0.05mg/kg,芬太尼2μg/kg可以减轻心血管反应,减少插管反应和插管知晓的发生率。
Objective To discuss the safety and effectiveness of using midazolam combined with fentanyl in fiberoptic bronchoscopy（FOB） leading tracheal intubation.Methods Twenty-eight patients assessed difficult airway were scheduled to do surgery under general anaesthesia.The patients were randomly divided into two groups.The control group only conducted with cricothyroid membrane puncture and Li Shuka table linen spray.While intravenous injection of midazolam 0.05mg/kg and fentanyl 2μg/kg was performed for the observation group under the base of local anaesthesia.MAP,HR and SpO2 were monitored before anaesthesia（T0）,when FOB was inserted into oral cavity（T1） and advanced through vocal cords（T2） and when endotraceal tub was threaded onto trachea（T3）.Responses like restlessness,nausea and coughing were also recorded.The patient＇s awareness of the intubation was noted after operation.Results The observation group has 13 good cases and 1 bad case,while the control group has 4 good cases and 10 bad cases.Through χ2 verification,0.025P0.05,there exist significant differences.It shows that using midazolam combined with fentanyl have good effects.For the control group,a significant rise（P0.05） in MAP and HR was observed at T1,T2 and T3.For the observation group,a significant rise（P0.05） in MAP and HR was observed at T2 and T3.MAP and HR of the observation group is lower than that of the control group.SpO2 of the observation group has a significant decrease in T1 compared to T0 and also lower than that of the control group at the same time phase.The intubation reflection and incidence rate of intubation awareness of the observation group is significantly lower（P0.01） than that of the control group.Conclusion Our research show that intravenous injection of midazolam 0.05 mg/kg and fentanyl 2μg/kg can significantly reduce cardiovascular and intubation reflections.Also the chances of awareness of intubation is reduced,leaving no psychology shadows to the patients.
出处
《安徽医学》
2011年第2期168-170,共3页
Anhui Medical Journal
