摘要
目的评价在无肌松药下瑞芬太尼复合异丙酚效应室靶浓度靶控输注(TCI)诱导时的气管插管条件。方法拟行气管插管全身麻醉的手术病人28例,ASA Ⅰ或Ⅱ级。诱导前静脉注射咪达唑仑0．03 mg/kg,以异丙酚和瑞芬太尼效应室靶浓度分别为3μg/ml和4 ng/ml TCI行麻醉诱导。监测诱导、插管过程中的血压、心率和脑电双频指数(BIS)。插管时按面罩通气难易、下颌松弛程度、声带位置高低、置入喉镜难易、是否有咳嗽体动以及对套囊充气反应等方面对插管条件进行评价。结果与插管前即刻比较,插管后即刻心率加快,插管后即刻及插管后1min血压升高(P<0．01)。插管前后的BIS值比较差异无统计学意义(P>0．05)。所有病人均一次插管成功。插管条件综合评价的满意率为67．9％。结论在无肌松药下以效应室靶浓度TCI瑞芬太尼4 ng/ml复合异丙酚3μg/ml麻醉诱导病人插管时可提供良好的气管插管条件。
Objective To evaluate the feasibility of tracheal intubation without muscle relaxant after induction of anesthesia with propofol-remifentanil given by target controlled infusion （TCI） . Methods Twentyeight ASA Ⅰ or Ⅱ patients of both sexes （15 males, 13 females） aged 18-67 yrs weighing 43-89 kg scheduled for elective operation under general anesthesia were studied. Midazolam 0.03 mg·kg^-1 was given i.v. as premedication. Anesthesia was induced with prepofol and remifentanil and both of them were given by TCI. The target effect site concentration of prepofol was set at 3 μg· ml^-1 and that of remifentanil at 4 ng· ml^-1. BP, HR and bispectral index （BIS） were monitored during induction and intubation. The results of tracheal intubation were graded as satisfactory, average and poor based on intubation conditions and intubation response including easiness of ventilating the patients via face mask, jaw relaxation, easiness of inserting laryngoscope and visualization of larynx, the vocal cord position and patients response to intubation such as cough, limb movement and response to cuff inflation. Results HR and BP were significantly increased within 1 min after intubation as compared to the baseline values before intubation （P 〈 0.01）. There was no significant difference in BIS values before and after intubation （31 ± 8 vs 35 ± 14）. All patients were successfully intubated at first attempt, 71.5% patients developed slight cough when the endotracheal tube was passed through the vocal cords. Nineteen patients （67.9%） were graded as satisfactory, six patients as average and three patients as poor. Conclusion Induction of anesthesia with TCI of propofol at target effect site concentration of 3 μg·ml^- 1 and remifentanil at 4 ng·ml^-1 might provide satisfactory intubation conditions without muscle relaxant.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2006年第4期293-295,共3页
Chinese Journal of Anesthesiology
