Comparative study of hemodynamic responses to orotra- cheal intubation with intubating laryngeal mask airway

Background Intubating laryngeal mask airway （ILMA） offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope （DLS）. Methods A total of 53 adult patients, ASA physical status I-II, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups. After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before （baseline values） and after anesthesia induction （post-induction values）, at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student＇s t test, and repeated-measures analysis of variance as appropriate. Results The mean intubation time in the ILMA group was longer than that in the DLS group （P〈0.05）. The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values （P〈0.05）, but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline （P〈0.05）. During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups. Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.     

GlideScope视频喉镜与光导纤维支气管镜经口气管插管对血流动力学影响的比较

目的比较全身麻醉诱导后采用GlideScope视频喉镜(GSVL)和光导纤维支气管镜(FOB)经口气管插管对血流动力学的影响。方法施择期整形外科手术患者57例,随机分为GSVL组(n=29)和FOB组(n=28)。在常规静脉麻醉诱导后实施气管插管操作。监测麻醉诱导前、后,气管插管时和气管插管后1、2、3、4、5min的血压和心率变化。结果GSVL组与FOB组气管插管时间差异无显著性(P>0·05)。气管插管后两组患者的血压和心率均比麻醉诱导后明显升高,但血压最大值未超过麻醉诱导前水平,而心率最大值较麻醉诱导前显著升高。两组在观察期各对应时间点的血压和心率及血压和心率最大值差异均无显著性(P>0·05)。结论GSVL经口气管插管可引起与FOB经口气管插管相同程度的心血管系统应激反应。     

光导纤维支气管镜与直接喉镜经口气管插管对小儿血流动力学的影响

目的对比观察小儿全身麻醉诱导后采用光导纤维支气管镜(FOB)和直接喉镜(DLS)经口气管插管对血流动力学的影响.方法选择美国麻醉医师协会Ⅰ～Ⅱ级、择期整形外科手术的小儿43例,随机分为DLS组(n=20)和FOB组(n=23),常规静脉麻醉诱导后进行经口气管插管.监测麻醉诱导前后、气管插管时和气管插管后5 min内的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率收缩压乘积(RPP)的变化.结果DLS组气管插管时的SBP、HR和RPP比麻醉诱导后显著升高(P＜0.05),但气管插管时的血压、HR和RPP与麻醉诱导前相比差异无显著性,观察期(从静脉麻醉诱导开始至气管插管后5 min为止)内SBP、HR和RPP的最大值显著高于麻醉诱导前(P＜0.05).FOB组气管插管时的血压、HR和RPP比麻醉诱导前和麻醉诱导后显著升高(P＜0.05),观察期血压、HR和RPP的最大值显著高于麻醉诱导前(P＜0.05).观察期各对应时间点的SBP和RPP两组间差异无显著性.气管插管时的HR在FOB组显著高于DLS组(P＜0.05),但观察期内其他各时间点的HR两组间差异无显著性.观察期血压和HR的最大值及其达最大值的时间两组间差异无显著性.结论临床常用的全身麻醉深度不能有效抑制FOB经口气管插管在小儿引起的加压反应和心率增快反应.与DLS相比,FOB在预防小儿经口气管插管的心血管系统应激反应方面无明显优越性.     

经可视喉罩与喉镜气管插管对患者血流动力学的影响

目的 比较可视性气管插管型喉罩通气道(LMA CTrachTM)与喉镜经口气管插管对全身麻醉患者血流动力学的影响.方法 福建泉州市儿童医院2009年1-8月美国麻醉医师协会(ASA)分级为Ⅰ～Ⅱ级拟在经口气管插管全身麻醉下实施择期妇科手术患者60例,数字随机法分为Ctrach(C)组和喉镜(D)组,每组30例,经常规静脉诱导后行气管插管.监测麻醉诱导前(基础值)、监测麻醉诱导后、气管插管即刻和气管插管后3 min内的血压(BP)和心率(HR)变化.结果 C组的平均气管插管操作时间较D组明显延长.气管插管后两组的BP和HR均比麻醉诱导后明显升高.D组在气管插管即刻和插管后HR较基础值显著升高;C组在气管插管即刻和气管插管后的BP和HR与基础值均差异无统计学意义.气管插管即刻和气管插管后,D组的BP、HR显著高于C组(P<0.05).结论 全身麻醉下采用LMA CTrachTM气管插管比喉镜插管对血流动力学影响更为平稳.     

Upsher喉镜与直接喉镜经口气管插管对血流动力学的影响

目的比较Upsher喉镜和Macintosh直接喉镜经口气管插管对血流动力学的影响。方法将50例ASAⅠ～Ⅱ级、实施择期整形外科手术的患者随机分为Upsher喉镜(U)组(n=25)和Macintosh直接喉镜(M)组(n=25),常规静脉麻醉诱导后分别采用Upsher喉镜或Macintosh直接喉镜实施经口气管插管操作,监测麻醉诱导前后、气管插管时和气管插管后5min内的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率-收缩压乘积(RPP)的变化,并记录气管插管时间。结果两组患者的气管插管时间差异无显著性(P>0.05)。麻醉诱导后两组患者的血压和RPP比麻醉诱导前显著降低(P<0.05);气管插管时的血压和RPP比麻醉诱导后显著升高(P<0.05),持续1～2min后逐渐降低至麻醉诱导后水平。观察期两组患者的血压升高幅度均未超过麻醉诱导前水平(P>0.05),但HR的最大值显著升高(P<0.05)。M组RPP的最大值比麻醉诱导前显著升高(P<0.05),而U组差异无显著性(P>0.05)。观察期各对应时间点的血压、HR和RPP在两组间差异无显著性(P>0.05)。结论Upsher喉镜和Macintosh直接喉镜经口气管插管可产生相似的心血管反应。临床常用的全身麻醉诱导用药剂量能有效抑制两种喉镜经口气管插管引起的加压反应,但不能抑制其引起的心率增快反应。与Macintosh直接喉镜相比,Upsher喉镜在预防经口气管插管的心血管系统应激反应方面无明显优越性。     

胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响

目的:对比观察胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响。方法:选择40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级、年龄19~66岁拟在经口双腔气管插管全身麻醉下施择期手术的胸外科患者,分别为常规全身麻醉诱导下直接喉镜双腔气管插管组(T组,20例)和常规全身麻醉诱导复合胸部硬膜外给予利多卡因后实施双腔气管插管组(E组,20例)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作,观察两组患者麻醉诱导前后及气管插管时和气管插管后5 min内的血压(blood pressure,BP)、心率(heart rate,HR)、二重指数(rate pressure product,RPP)和脑电双频指数(bispectral index,BIS)的变化,并记录气管插管时间。结果:麻醉诱导后,两组患者的BP和RPP均较麻醉诱导前明显降低。与麻醉诱导后相比较,气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较,气管插管后E组患者BP明显降低,T组患者收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和平均动脉压(mean arterial pressure,MAP)明显升高,且持续时间约1 min。两组患者气管插管后HR均明显升高,T组患者HR增快持续约4 min,E组患者HR增快持续约1 min。与E组相比较,观察期内气管插管后T组SBP、DBP、MAP、HR和RPP均明显升高。与基础值相比,两组患者麻醉诱导后和气管插管后的BIS值均明显降低,且两组之间差异无统计学意义。与E组比较,观察期T组SBP大于基础值30%和RPP大于22 000的发生率明显较高,且E组中未见SBP大于基础值30%和RPP大于22 000的患者。结论:在双腔气管插管期间,硬膜外给予利多卡因可明显减轻插管导致的剧烈血流动力学变化,但对唤醒反应无影响。     

改良法与常规法GlideScope视频喉镜经口气管插管的比较

目的:通过与常规法比较,评估改良法GlideScope~(R)视频喉镜经口气管插管在操作和患者血流动力学改变上有无优势.方法:选择ASAⅠ～Ⅱ级、年龄21～53岁、拟在经口气管插管全身麻醉下施择期腹部外科手术的60例患者,随机分为常规组和改良组,每组30例.常规全麻诱导,常规组按照先置入GlideScope~(R)视频喉镜镜片,再置入气管导管的顺序经口气管插管,改良组按照先置入气管导管,再置入GlideScope~(R)视频喉镜镜片的顺序经口气管插管,记录气管插管操作时间,记录诱导前、诱导后、气管插管时和插管后1、3 min的血压及心率变化.结果:改良组的操作时间短于常规组;两组在气管插管时均引起血压和心率的上升,但两组间比较无统计学意义.结论:改良法能改善GlideScope~(R)视频喉镜经口气管插管的操作简便性,但还不能改善其对血流动力学的影响.     

GlideScope视频喉镜、直接喉镜和光导纤维支气管镜经鼻气管插管时血流动力学反应的比较

目的比较采用GlideScope视频喉镜(GSVL)、Macintosh型直接喉镜(MDLS)和光导纤维支气管镜(FOB)实施经鼻气管插管时的血流动力学反应。方法将美国麻醉医师协会(ASA)身体状况分级为Ⅰ~Ⅱ级、年龄18~50岁、拟在经鼻气管插管全身麻醉下施择期整形外科手术的60例患者随机分为GSVL组、MDLS组和FOB组,每组20例。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经鼻气管插管操作。观察记录麻醉诱导前基础值、麻醉诱导后值,气管插管时和气管插管后5min内每间隔1min的血压(BP)和心率(HR),并记录观察期BP、HR的最大值和最小值,计算各时间点的心率收缩压乘积(RPP)。以时间为横坐标及观察期BP和HR的变化为纵坐标计算气管插管后观察期血流动力学时-效关系曲线下面积(AUE)。结果3组的基本情况和气管插管时间差异无显著性。麻醉诱导后3组的BP和RPP较基础值显著降低(P<0.05),而HR无显著性变化。经鼻气管插管导致3组的BP、HR和RPP较麻醉诱导后值显著升高(P<0.05)。与基础值相比,气管插管时FOB组的BP、HR和RPP均显著升高(P<0.05),MDLS组气管插管时的HR以及观察期舒张压、平均动脉压、HR和RPP的最大值显著升高(P<0.05),但GSVL组气管插管时和气管插管后的各项血流动力学指标与基础值差异均无显著性。FOB组气管插管时的各项血流动力学指标和观察期HR>100bpm的发生率显著高于GSVL组和MDLS组(P<0.05);虽然观察期的BP在MDLS组和GSVL组之间差异无显著性,但MDLS组气管插管时和气管插管后的HR和RPP以及AUEHR显著高于GSVL组(P<0.05)。GSVL组的AUEHR和AUESBP显著低于FOB组(P<0.05)。结论实施经鼻气管插管时的血流动力学反应在采用FOB时最强,MDLS次之,GSVL最轻。     

Circulatory responses to nasotracheal intubation: comparison of GlideScope® videolaryngoscope and Macintosh direct laryngoscope

Background The GlideScope videolaryngoscope （GSVL） has been shown to have no special advantage over the Macintosh direct laryngoscope （MDL） in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation （NTI） using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL.
Methods Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure （BP） and heart rate （HR） were recorded before induction （baseline values） and immediately before intubation （post-induction values）, at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP （SBP） and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes 〉 30% of baseline values were also noted. The product of HR and systolic BP, i.e. rate pressure product （RPP）, and the areas under SBP and HR vs. time curves （AUGsBP and AUGHR） were calculated.
Results The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUGSBP, maximum values of BP and incidence of SBP percent increase 〉 30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUGHR and incidence of HR percent increase 〉 30% of baseline value were significantly higher in the MDL group than in the GSVL group. Times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group.
Conclusions The pressor     

GlideScope视频喉镜经口气管插管的临床评价

目的观察比较GlideScope视频喉镜和普通Macintosh直接喉镜经口气管插管的临床效果。方法选择60例ASA分级Ⅰ-Ⅱ级,拟经口气管插管全麻下择期手术的患者,随机分为GlideScope视频喉镜组（G组,n=30）和Macintosh直接喉镜组（M组,n=30）。麻醉诱导后,观察并记录两组基础值、诱导后、声门暴露即刻、气管插管即刻和插管成功后1、2、5 min时的心率和无创血压,同时记录插管时声门暴露程度（Cormark-Lehane分级）、插管时间、一次性插管成功率和插管并发症（如咽痛、声嘶等）。结果 G组在声门暴露时的心率和无创血压升高程度显著小于M组;G组心率和无创血压最大值出现在插管时,而M组最大值多出现在声门暴露时。Cormark-Lehane分级G组（Ⅲ1例）明显比M组（Ⅲ6例）低（P〈0.05）;G组插管时间（29.1±2.6）s与M组（31.4±4.3）s差异无统计学意义（P〉0.05）;G组一次性插管成功率100%,M组为86.7%;G组未出现插管并发症,M组有3例出现咽痛,均自行缓解。结论与Macintosh型直接喉镜相比,GlideScope视频喉镜可以明显改善声门暴露,降低插管难度,提高插管成功率,减少并发症,但并不能减轻气管插管的应激反应。     

甲氧明联合阿托品预防老年患者全麻诱导期低血压的临床观察

目的:观察临床应用甲氧明联合阿托品在老年患者全麻诱导期血流动力学的变化。方法:选择ASAⅠ～Ⅱ级择期行全麻腹腔镜胆囊切除术患者90例,随机分成3组,每组30例,Ⅰ组作为对照组常规诱导,其余两组分别在全麻诱导时稀释后静脉缓慢推注甲氧明2mg(Ⅱ组)和阿托品0.5mg+甲氧明2mg(Ⅲ组)。三组中当收缩压下降超过基础值的20%时追加麻黄素10mg。记录诱导前基础值和诱导后1min,3min,5min各组患者收缩压,舒张压,心率的值及麻黄素追加的例数。结果:与基础值比较,Ⅰ组收缩压,舒张压和心率有明显变化(P<0.05),麻黄素的追加次数明显超过Ⅱ组和Ⅲ组(P<0.05);Ⅱ组收缩压,舒张压无明显统计学差异(P>0.05),心率有明显变化(P<0.05);Ⅲ组收缩压,舒张压及心率均无明显统计学差异(P>0.05)。结论:甲氧明能有效地降低低血压的发生,阿托品能够预防心率减慢,甲氧明与阿托品联合应用使老年患者全麻诱导期血流动力学更加稳定。     

帝视内窥镜引导全麻患者经口气管插管的可行性

目的对比帝视内窥镜和视可尼气管插管的有效性和安全性,评价帝视内窥镜引导全身麻醉(以下简称全麻)患者经口气管插管的可行性。方法拟气管插管全身麻醉患者60例,分为帝视内窥镜组(D组)和视可尼组(S组)各30例,分别采用帝视内窥镜和视可尼引导气管插管,观察并记录插管时间、插管次数、血流动力学变化以及合并症。结果 D组30例患者中有29例气管插管成功,其中1次成功者27例(90%),2次成功者2例(7%),失败者1例(3%),总体成功率97%,插管时间为(34.0±21.7)s;S组30例患者均气管插管成功,其中1次成功者28例(93%),2次成功者2例(7%),总体成功率100%,插管时间(44.8±33.1)s。2组插管前后血流动力学无显著变化。2组插管咽痛、声嘶等合并症发生率均较低。结论全麻患者使用帝视内窥镜气管插管成功率高、血流动力学影响小、合并症少,是临床可用的一种气管插管方法。     

瑞芬太尼复合依托咪酯麻醉诱导下气管插管的血流动力学变化

目的对比瑞芬太尼复合依托咪酯麻醉诱导与芬太尼复合依托咪酯麻醉诱导后气管插管血流动力学的变化。方法40例患者分为瑞芬太尼组与芬太尼组,诱导后2min行气管插管术。分别记录诱导前、诱导后1min及插管后2min的平均动脉压（MAP）和心率（HR）。插管务件由操作者给予评分。结果两组诱导后MAP和HR较诱导前均下降,差异有统计学意义（P〈0．05）。插管后两组间的MAP差异有统计学意义（P〈0．05）。结论瑞芬太尼复合依托咪酯麻醉诱导在押制插管引起的心血管反应方面瑞芬太尼组优于芬太尼组。     

插管型喉罩联合气管插管在俯卧位手术患者中疗效观察

目的探讨插管型喉罩(ILMA)联合气管插管在俯卧位手术患者中应用临床效果及安全性。方法 80例择期需俯卧位手术的患者通过随机数字表法分成两组,气管导管组(ET_组)和插管型喉罩组(ILMA组),各40例。ET组患者诱导麻醉后行气管插管,术后各项拔管指征恢复后拔除气管导管。ILMA组患者诱导麻醉后先插入配套喉罩,5 min后气管导管经插管型喉罩置入,术后平卧位后深麻醉下拔除气管导管,留置喉罩,待各项拔管指征恢复后拔除喉罩。记录两组T_0(麻醉诱导前),T_1(诱导用药后插入喉罩或气管导管前),T_2(气管导管插入时),T_3(切皮时),T_4(术中),T_5(拔除气管导管或喉罩时)5个时段的心率(HR)、平均动脉压(MAP)。且观察苏醒期间的苏醒时间(T_6)、自主呼吸恢复时间(T_7),以及评估苏醒期间的并发症如躁动、恶心呕吐等发生情况。结果 ILMA组T_2、T_5时段HR、MAP显著低于ET组(P0.05);术后苏醒质量方面,ILMA组T_6、T_7显著短于ET组(P0.05),术后呛咳、躁动发生率也显著低于ET组(P0.05)。结论俯卧位手术的患者麻醉时采用插管型喉罩全麻的血流动力学更稳定,术后麻醉苏醒质量更高,安全性及可控性好。     

急诊内快速顺序插管在脑外伤及脑卒中患者中的应用

目的：观察快速顺序插管（RSI）技术在脑外伤及脑卒中患者急诊气管插管中的临床应用效果。方法：98例脑外伤及脑卒中符合研究入选标准的患者,根据随机数字表随机分成试验组、对照组各49例,试验组行RSI,对照组行部分镇静表面麻醉下经口气管内插管,观察记录喉部显露的C/L（Cormack-Lehane）分级、插管时间、插管次数、血压变化、心率变化、SPO2的最低下降值及并发症;计算IDS评分及比较总体有效率。结果：两组插管时间试验组（20.05±5.50）s比对照组（31.58±9.34）s短,差异有统计学意义（P〈0.05）;试验组声门显露的C/L分级、插管次数、插管过程中收缩压、心率波动及SPO2的最低下降值均显著优于对照组（P〈0.01）;试验组并发症发生率低,其IDS评分及总体有效率（93.87%）显著优于对照组（p〈0.01）。结论：RSI应用于脑外伤及脑卒中患者急诊气管插管安全迅速有效,对比部分镇静表面麻醉下经口气管内插管有明显优势,值得临床推广。     

Comparison of bolus remifentanil versus bolus fentanyl for blunting cardiovascular intubation responses in children: a randomized, double-blind study

Background The authors found no study to compare the efficacy of bolus dose fentanyl and remifentanil blunting the cardiovascular intubation response in children, so they designed this randomized, double-blind clinical study to assess the effects of remifentanil 2 μg/kg and fentanyl 2 μg/kg by bolus injection on the cardiovascular intubation response in healthy children.
Methods One hundred and two children, the American Society of Anesthesiologists （ASA） physical status 1-2 and scheduled for elective plastic surgery under general anesthesia, were randomly divided into one of two groups to receive the following treatments in a double blind manner： remifentanil 2μg/kg （Group R） and fentanyl 2 μg/kg （Group F） when anesthesia was induced with propofol and vecuronium. The orotracheal intubation was performed using a direct laryngoscope. Blood pressure （BP） and heart rate （HR） were recorded before anesthesia induction （baseline values）, immediately before intubation, at intubation and every minute for 5 minutes after intubation. The percent changes of systolic blood pressure （SBP） and HR relative to baseline values and the rate pressure product （RPP） at every observing point were calculated. The incidences of SBP and HR percent changes 〉30% of baseline values and RPP 〉22 000 during the observation were recorded.
Results There were no significant differences between groups in the demographic data, baseline values of BP and HR and the intubation time. As compared to baseline values, BP, HR and RPP at intubation and their maximum values during observation increased significantly in Group F, but they all decreased significantly in Group R. BP, HR and RPP at all observed points, and their maximum values during the observation, were significantly different between groups. There were also significant differences between groups in the percent change of SBP and HR relative to baseline values at all observed points and their maximum percent changes during the observation. The incidences of SBP and HR percent increased 〉30% of the baseline values and RPP 〉22 000 during the observation, were significantly higher in Group F than in Group R, but the incidences of SBP and HR percent decreased 〉30% of baseline values were significantly lower in Group F compared with Group R.
Conclusions When used as part of routine anesthesia induction with propofol and vecuronium in children, fentanyl 2 μg/kg by bolus injection fails to effectively depress the cardiovascular intubation response. Remifentanil 2 μg/kg by bolus injection can completely abolish the cardiovascular intubation response, but also cause more adverse complications of temporary siclnificant cardiovascular depression.     

Comparison of hemodynamic changes after endotracheal intubation by using the lighted stylet and the laryngoscope in patients

Objective To compared the effects of the lighted stylet technique on hemodynamic responses, time- to- intubation, number of attempts, and complications during tracheal intubation with those of direct- vision laryngoscopy in patients. Methods Forty patients were randomly assigned to one of the following two groups: 1) patients intubated by using the laryngoscope (A group, n = 20); 2) patients intubated by using the lighted stylet( B group, n= 20). Lighted styletor laryngoscopic oral endotracheal in- tubation was performed after the induction of anesthesia with fentanyl and propofol and muscle relaxation. Systolic blood pressure, diastolic blood pressure, and heart rate were recorded, and the change from "be- fore intubation"to "immediately after intubation"in each variable was calculated. Results In two groups , SBP and DBP were significantly decreased from the baseline level by the induction of anesthesia (P< 0.05). In Bgroup, SBP and DBP were increased transiently to the level of baseline by intubation. Heart rate (HR) increased transiently after intubation in both A and B groups. Significantly higher changes from "before intubation"to "immediately after intubation"in SBP were observed in the A group compared with the B group (P<0.05). Values of SBP and DBP were significantly greater in the A group than in the B group, respectively, in immediately after tracheal intubation and 1min after tracheal intubation . Conclu- sions We conclude that the lighted stylet technique required significantly a longer time to intubation than the laryngoscopic technique in patients. However, the lighted style ttechnique significantly attenuated hemodynamic changes tointubation in comparison with the laryngoscopic technique in patients.     

依托咪酯应用于心血管患者麻醉诱导的临床疗效观察

目的探讨分析心血管患者麻醉诱导中使用依托咪酯的效果。方法回顾性分析2015年1月至2019年10月本院收治的84例心血管患者,采用随机抽取法分为研究组和对照组,各42例。研究组麻醉诱导后使用依托咪酯,对照组麻醉诱导时使用依托咪酯。比较两组不同时间点(诱导前、麻醉诱导后1 min、3 min和插管后1 min、3 min和拔管时)的平均动脉血压、心率和SPO2值变化及麻醉效果和麻醉后VAS评分。结果诱导前,两组平均动脉血压、心率和SPO2值比较差异无统计学意义;麻醉诱导后1 min、3 min和插管后1 min、3 min,研究组平均动脉血压低于对照组(P<0.05);两组麻醉诱导后1 min、3 min和插管后1 min、3 min和拔管时心率和SPO2值比较差异无统计学意义,与诱导前比较差异无统计学意义。两组麻醉效果比较差异无统计学意义,研究组麻醉后VAS评分低于对照组(P<0.05)。结论在心血管患者麻醉诱导后使用依托咪酯麻醉效果显著,对患者平均动脉血压无明显影响,可降低麻醉后疼痛,值得临床推广应用。     

帝视可视内窥镜联合右美托咪定在老年高血压患者气管插管中的应用

目的：探讨帝视可视内窥镜（Discopo）联合右美托咪定在老年高血压患者全麻气管插管中的应用价值。方法选择老年高血压患者120例,随机分为 Discopo组（ D 组）、Discopo 联合右美托咪定组（ DD 组）、Macintosh 喉镜组（ M组）、Macintosh喉镜联合右美托咪定组（MD组）,每组30例。 MD组和DD组于麻醉诱导前静脉泵注右美托咪定0．6μg／kg,M组和D组静脉泵注等容量的生理盐水;麻醉诱导后,相应组别分别使用Discopo或Macintosh喉镜实施经口气管内插管。观察和记录在麻醉诱导前（T0）、诱导后插管前（T1）、插管后1 min（T2）、3 min（T3）和5 min（T4）时各组患者的收缩压、舒张压、心率,于T0、T2及T4检测各组患者的血浆肾上腺素、去甲肾上腺素浓度。统计插管一次成功率、插管时间和插管并发症发生率。结果4组均顺利完成气管内插管,D组及DD组一次插管成功率高于M组及MD组（P＜0．05）,且插管时间短于M组及MD组（P＜0．05）,D组及DD组未发生并发症,M组插管后咽痛3例,MD组插管后咽痛2例。4组间心率、收缩压及舒张压比较,差异有统计学意义（P＜0．05）,与其他组比较, DD组患者T2时血压和心率均明显降低。4组不同时间点心率、收缩压及舒张压比较,差异有统计学意义（P＜0．05）,除DD组,其他3组患者T2的血压和心率均明显高于T1,且M组T3时仍明显升高。4组血浆肾上腺素及去甲肾上腺素浓度比较,差异有统计学意义（P＜0．05）,DD组T2和T4的血浆肾上腺素及去甲肾上腺素浓度低于其他组,而MD组低于M组。4组不同时间点肾上腺素及去甲肾上腺素比较,差异有统计学意义（ P＜0．05）,除DD组,其他3组的肾上腺素及去甲肾上腺素浓度在 T2均明显升高,且M组T4的肾上腺素及去甲肾上腺素浓度仍高于基础值（ T0）。结论 Discopo一次插管成功率高且对患者损伤小,Discopo联合右美托咪定对老年高血压患者气管插管应激水平具有保护作用。     

右美托咪定对气管插管全麻老年高血压病人血流动力学的影响

目的研究右美托咪定对气管插管全麻老年高血压病人血流动力学的影响。方法选取60例行气管插管全麻老年高血压病人,分为对照组（给予0.9%氯化钠溶液）和观察组（给予右美托咪定）,各30例。比较2组麻醉时间、手术时间、苏醒时间、拔管时间和不同时间点血压及心率变化及不良反应的发生情况。结果2组麻醉时间和手术时间差异均无统计学意义（P>0.05）;但观察组苏醒时间及拔管时间均较对照组缩短（P < 0.05和P < 0.01）。2组入室前、插管前1 min血压及心率差异均无统计学意义（P>0.05）;观察组插管即刻、插管后1 min、拔管前1 min、拔管后1 min血压及心率均较对照组明显降低（P < 0.01）。2组病人口干、低血压、寒战、心动过缓及苏醒延迟等不良反应发生率差异无统计学意义（P>0.05）。结论在行气管插管全麻老年高血压病人中,采用右美托咪定麻醉可减少病人血压及心率波动,促进血流动力学稳定,且不会引起严重不良反应,故具有良好的安全性。