七氟烷复合瑞芬太尼用于无肌松药气管插管的可行性

目的观察不使用肌松药的情况下七氟烷复合瑞芬太尼诱导行气管插管的插管效果以及对血流动力学的影响,评价其可行性。方法择期全麻手术患者50例,ASAⅠ或Ⅱ级,年龄20～60岁,体质量45～75 kg,随机分为两组,每组25例：七氟烷复合瑞芬太尼组（S组）和对照组（C组）。麻醉诱导：S组：调节七氟烷挥发罐刻度致8%,氧流量6 L/min,指导患者肺活量法面罩吸入七氟烷,待患者睫毛反射消失时,静脉缓慢注射瑞芬太尼1.5μg.kg-1,注射时间不小于1 min。注射完毕60 s后,关闭七氟烷挥发罐,气管插管后行机械通气。C组：丙泊酚2.0μg.kg-1,瑞芬太尼1.0μg.kg-1,罗库溴铵0.6 mg.kg-1,麻醉诱导后行气管插管机械通气。于诱导前、睫毛反射消失时、气管插管前即刻以及气管插管后的即刻、1 min、3 min和5 min,分别记录MAP、HR、SpO2和BIS值;采用Helbo-Hansen评分系统评价气管插管条件。结果所有患者均完成气管插管,气管插管成功率为100%,两组间满意率差异无统计学意义。两组在诱导后MAP和HR均下降;与气管插管前即刻比较,两组气管插管后即刻MAP有所上升（P〈0.05）,而HR变化无统计学意义。两组气管插管前、后BIS值维持于40～60,各时点组间差异无统计学意义。结论七氟烷复合瑞芬太尼能提供良好的气管插管条件,且血流动力学较平稳,适用于患者无肌松药条件下气管插管。

Efficacy of induction with sevoflurane combined with remifentanil for tracheal intubation without muscle relaxants

Objective To evaluate the efficacy of induction with sevoflurane combined with remifentanil for tracheal intubation without muscle relaxants.Methods Fifty ASA ⅠorⅡ patients,aged 20~60 yr,weighing 45~75 kg,were randomly divided into 2 groups(n=25 each): sevoflurane combined with remifentanil group(group S) and control group(group C).Anesthesia was induced with inhalation of 8% sevoflurane in 100% oxygen.Sevoflurane was inhaled initially with high-flow oxygen(6L/min).When the patient's eyelash reflex disappeared,remifentanil 1.5 ug·kg-1 in group S was injected slowly over 1 min.60s later sevoflurane inhalation was then stopped.The patients were mechanically ventilated after tracheal intubation.In group C,anesthesia was induced with propofol 2 mg·kg-1,rocuronium 0.6 mg·kg-1and remifentanil 1ug·kg-1.MAP,HR,SpO2 and BIS were recoded before administration,at the time of disappearance of eyelash reflex,immediately before and after tracheal intubation,and 1,3 and 5 min after tracheal intubation.Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy,jaw relaxation,position of vocal cords,degree of coughing and limb movement.Results All patients were successfully intubated at first attempt.The difference of the satisfactory intubation conditions was not statistically significant(P>0.05).Compared to the time of disappearance of eyelash reflex,the decrease in MAP and HR were significant in both groups.MAP increased significantly at post-intubation compared to pre-intubation(P<0.05),and HR remained stable.The incidence of hypotension and bradycardia in two groups was no significant difference(P>0.05).BIS value was maintained at 40-60 before and after tracheal intubation.Conclusion 8% Sevoflurane combined with remifentanil and sufentanil can provide acceptable tracheal intubating conditions and satisfactory hemodynamic stability,and can be used for tracheal intubation without muscle relaxants.