摘要
目的观察舒芬太尼不同血浆靶控浓度输注对纤维支气管镜(FOB)清醒经鼻插管应激反应的影响。方法择期困难气道患者45例,拟行清醒经鼻FOB插管,随机分为3组,每组15例。Ⅰ组、Ⅱ组、Ⅲ组舒芬太尼血浆靶控浓度分别为0.3,0.5,0.8 ng·mL-1;由入手术室后5 min作为基础值(t0),各组达预设靶浓度(t1),插管即刻窥视会厌(t2),插管后1 min(t3),插管后3 min(t4),观察心率(HR)、收缩压(SBP)、舒张压(DBP),脉搏氧饱和度(SpO2)变化;计算心率收缩压乘积(RPP);在t0、t1、t3、t4抽取动脉血离心后检测血清肾上腺素(E)、去甲肾上腺素(NE),皮质醇(Cor)。记录插管过程中不良反应。结果 HR在Ⅱ组t2、t3时点分别为(81±11),(78±11)次.min-1,在Ⅲ组t2、t3时点分别为(78±18),(76±19)次.min-1,均显著低于Ⅰ组同时点(P<0.05);SBP、DBP、RPP:Ⅱ组、Ⅲ组在t2、t3时点均显著低于Ⅰ组同时点(P<0.05);SpO2:Ⅲ组t1时点为(90±10)%,显著低于Ⅰ组、Ⅱ组(P<0.05);NE、E、Cor:Ⅰ组NE、Cor值在t3时点分别为(3 668±716),(4 356±107)pmol·L-1,在t4时点分别为(3 025±365),(3 517±696)pmol·L-1,与t0比较均显著升高(P<0.05)。Ⅱ组、Ⅲ组与Ⅰ组t3、t4时点NE、Cor差异显著(P<0.05),t4时点E差异显著(P<0.05);不良反应发生情况:Ⅲ组发生呼吸抑制2例,手托下颌面罩吸氧后SpO2恢复正常。结论舒芬太尼血浆靶控输注0.5 ng·mL-1能有效抑制FOB插管过程中的应激反应,且无呼吸抑制发生。
Objective To compare the effects of different dosage of target controlled infusion （TCI） of sufentanil on stress response in awake nasotracheal fibreoptic （FOB） intubation. Methods Forty-five patients ASA Ⅱ or Ⅲ, aged 18 to 60 years, scheduled for awake nasotracheal fiberoptic intubation, were randomly assigned into three groups （n = 15 for each group） ： group I , sufentanil target plasma concentration （Cp） of 0.3 ng · mL-1 ; group Ⅱ , Cp of 0.5 ng · mL-1 and group m, Cp of 0. 8 ng · mL-1. HR, SBP, DBP, SpO2 and RPP were recorded 5 min after patients arriving at operation room （ to ） , when each group reached target plasma concentrations （ t1 ）, at the time of intubation and seeing the epiglottis （ t2 ）, 1 min after intubation （ t3 ） , and 3 min after intubation （ t4 ）. Arterial blood samples were taken to determine the plasma concentrations of epinephrine （E）, norepinephrine （NE） and cortisol （Cor） at all time points. Adverse reactions throughout the process were recorded. Results HR at t2 and t3 was （81±11） and （78±11） times· min-1 in groupⅡ and （78±18） and （76±19） times · min-l in group Ⅲ, respectively. HR in group Ⅱ and Ⅲ was significantly lower than that in group I （ P〈0.05 ）. SBP and DBP in group Ⅲ at t1 -t4 and group 11 at t2 , t3 were significantly lower than those in group I of the corresponding time points （P〈0.05）. RPP in group Ⅱ and Ⅲ at t1 was lower than that at to, while the PtPP in group I at t2 and t3 was significantly higher than that at t0（P〈0. 05）. SpO2 at t1 in group Ⅲ was （90±10）% , significantly lower than that in group I and 11 （P〈 0.05）. In group I , NE and Cor were （3 668±716） and （4 356±107） pmol · L-1 at t3, and （3 025±365） and （3 517±696） pmol · L-1 at t4, which were significantly higher than those at to （P〈0.05）. In group Ⅲ, two patients developed respiratory depression, which was alleviated by using oxygen mask. Conclusion The pla
出处
《医药导报》
CAS
北大核心
2013年第6期723-726,共4页
Herald of Medicine
基金
河北省卫生厅科研基金资助项目(20090387)
关键词
舒芬太尼
不同剂量
困难气道
应激反应
靶控输注
Sufentanil/Different dosage
Difficult airway
Stress response
Target controlled infusion
