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。     

Shikani喉镜和Macintosh直接喉镜经口气管插管对血流动力学影响的比较

目的 比较Shikani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41例美国麻醉医师协会(ASA)I～Ⅱ级、年龄20～60岁和拟在经口气管插管全身麻醉下实施择期手术的患者随机分为Shikani喉镜组(S组,n=21)和Macintosh直接喉镜组(M组,n=20),麻醉诱导后分别采用Shikani喉镜或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,气管插管时和气管插管后5 min内的血压、心率(HR)和二重指数(RPP)变化,记录气管插管时间.结果 两组患者麻醉诱导后的血压和RPP明显低于麻醉诱导前(P均＜0.05),气管插管后的血压、HR和RPP则明显高于麻醉诱导后(P均＜0.05).与麻醉诱导前相比,两组患者气管插管后的HR明显升高(P均＜0.05),且均持续约3 min.在插入气管导管后即刻,M组患者的收缩压(SBP)和外周平均动脉压(MAP)明显高于S组患者(P均＜0.05),其余各时间点两组患者的血流动力学指标差异均无统计学意义(P均＞0.05).在M组,患者观察期和气管插管完成后HR出现最大值的时间较SBP出现最大值的时间明显后延(P均＜0.05);与M组比较,S组患者观察期和气管插管完成后出现SBP最大值的时间明显后延(P均＜0.05).两组患者观察期SBP大于、小于基础值30%,HR大于、小于基础值30%及RPP大于22 000的发生率差异均无统计学意义(P均＞0.05).两组患者的气管插管时间差异无统计学意义(P＞0.05).结论 Shikani喉镜正中入路经口气管插管的血流动力学反应轻于Macintosh直接喉镜气管插管.     

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。     

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。     

帝视内镜GlideScope视频喉镜与直接喉镜经口气管插管血流动力学反应的比较

目的:比较帝视内镜(DISCOPO)、GlideScope视频喉镜与直接喉镜(Maciniosh direct laryngoscope,DLS)经口气管插管时血流动力学反应.方法:择期行全身麻醉手术患者90例,ASA分级Ⅰ或Ⅱ级,无困难气道,无心肺疾病,随机分为帝视内镜组(DS组)、GlideScope视频喉镜组(GS组)和直接喉镜组(DLS组),每组30例.记录麻醉前基础值(T1)、麻醉诱导后(T2)、插管成功即刻(T3)及插管后1 min (T4)、3 min (T5)、5 min(T6)的SBP、MAP、HR、气管插管时间,计算心率收缩压乘积(RPP).结果:3组均顺利完成气管内插管.各组诱导后T2时MAP、HR和RPP都较T1时显著降低(P＜0.05),插管后T3、T4时的MAP、HR和RPP均较诱导后T2时显著升高(P＜0.05).与T1比较,DS组T3～T6时差异无统计学意义.GS组、DLS组,与T1时比较,T3和T4时的MAP、RPP和HR显著升高(P＜0.05),T5、T6时无统计学意义.组间比较,GS组与DLS组在各观察时点均无统计学差异,但T3、T4时,GS组、DLS组MAP、HR、RPP指标明显高于DS组,差异有统计学意义(P＜0.05),T1、T2、T5和T6时与DS组比较无统计学差异.结论:3种方法经口气管插管对血流动力学均有影响,帝视内镜气管插管对血流动力学的影响较轻.     

普通气管导管预热后用于经鼻明视气管插管的临床观察

目的:探讨普通气管导管预热后用于经鼻明视气管插管的临床效果.方法:将70例ASA Ⅰ-Ⅱ级、需经鼻气管插管的择期手术患者随机均分为两组,常规麻醉诱导后,分别采用预热后的普通气管导管(实验组)和鼻气管导管<对照组)行经鼻明视气管插管.记录麻醉诱导后、气管插管时和气管插管后1、3、5min时的血压(BP)和心率(HR)及其观察期的最大值,并计算各时点心率.收缩压乘积(RPP),记录气管插管时间和插管顺利程度,并对患者鼻黏膜损伤情况和术中导管折弯发生率进行观察,结果:两组患者间各时点的BP、HR和RPP及最大值,气管插管时问和插管顺利程度,以及鼻黏膜损伤情况比较筹异无显著性统计学意义(P＞0.05),而对照组术中导管折弯发生率较高(P＜0.05＝.结论:普通气管导管预热后用于经鼻明视气管插管可取得良好的临床效果,且成奉低廉,具有较好临床实用价值.     

小剂量瑞芬太尼和舒芬太尼预防小儿经口气管插管心血管反应的比较

目的:比较小剂量瑞芬太尼和舒芬太尼对小儿直接喉镜经口气管插管心血管反应的影响。方法:选择施择期整形外科手术的小儿90例,随机平均分成对照组、瑞芬太尼组和舒芬太尼组。在气管插管前采用盲法分别应用生理盐水、瑞芬太尼1g·kg~(-1)和舒芬太尼0.2g·kg~(-1)。在静脉麻醉诱导后采用直接喉镜实施经口气管插管。记录麻醉诱导前(基础值)、后(麻醉诱导后值),气管插管时和气管插管后5min内的血压和心率(HR)以及观察期收缩压(SBP)和HR的变化率。结果:气管插管导致三组的血压和HR较基础值显著升高,并且对照组较瑞芬太尼组和舒芬太尼组显著升高。瑞芬太尼组和舒芬太尼组观察期SBP和HR增加大于基础值30%的发生率较对照组显著降低。在整个观察期,瑞芬太尼组和舒芬太尼组的血压和HR及其观察期的最大值无显著差异。结论:瑞芬太尼1g·kg~(-1)和舒芬太尼0.2g·kg~(-1)对小儿直接喉镜经口气管插管心血管反应具有类似的抑制作用。     

选择性β1-肾上腺素能受体阻滞剂艾司洛尔对光导纤维支气管镜引导经鼻气管插管血流动力学的影响

目的：通过艾司洛尔对光导纤维支气管镜(FOB)引导经鼻气管插管血流动力学的影响,探讨有效抑制FOB引导经鼻气管插管时心血管反应的方法。方法：拟在经鼻气管插管全身麻醉下实施口腔和耳鼻喉科手术患者35例, ASAⅠ～Ⅱ级,随机分为FOB引导经鼻气管插管艾司洛尔组（艾司洛尔组）和单纯FOB引导经鼻气管插管组（对照组）,艾司洛尔组前者在气管插管前2 min静脉注射艾司洛尔1 mg•kg^-1,测定麻醉诱导前后、插入气管导管时以及气管插管后1、2、3、4和5 min的SBP、DBP、MBP、HR和SpO₂的变化。结果:艾司洛尔组在插入气管插管时的心率(HR)明显低于对照组（Ｐ＜0.05）, 在插入气管导管后1 min 收缩压(SBP)、舒张压(DBP)和平均动脉压(MBP)明显低于对照组（Ｐ＜0.05）,SBP、DBP、MBP和HR的最大值亦明显低于对照组（Ｐ＜0.05）;两组患者插管前后的SpO₂均保持在96%以上。 结论：临床常用麻醉深度不能完全抑制FOB引导经鼻气管插管操作导致的血压升高和心率增快反应;在气管插管前2 min静脉注射艾司洛尔1 mg•kg^-1可有效抑制FOB引导经鼻气管插管的心血管反应。     

利多卡因氟哌利多减轻气管插管时心血管副反应的研究

目的 :观察利多卡因复合氟哌利多在减轻插管时 (后 )反应的临床效果。方法 :将 72例病人随机分为对照组 (A组 ,3 8例 )和实验组 (B组 ,3 4例 ) ,比较两组在麻醉诱导、气管插管时 (后 )收缩血压 (SBP)、心率 (HR)和心率与收缩血压乘积 (RPP) ,并观察心电图 (ECG)情况。结果 :SBP、HR和RPP两组于诱导前、诱导后均无显著性差异 (P均 >0 .0 5 ) ,但插管时、插管后A组后均显著高于B组 (P <0 .0 5或 <0 .0 1) ;窦性心动过速发生率A组非常显著高于B组 (P <0 .0 1) ,但室性早搏频发率两组无显著性差异 (P >0 .0 5 )。结论 :利多卡因复合氟哌利多能有效地预防气管插管时心血管副反应     

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。     

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     

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.     

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.     

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.     

不同剂量艾司洛尔对气管插管时心血管反应的预防作用

目的观察不同剂量艾司洛尔对气管插管时心血管反应的预防作用。方法选取北京航天总医院100例择期手术患者随机分成5组,A组（对照组）、B组（艾司洛尔05mg／kg）、C组（艾司洛尔10mg／kg）、D组（艾司洛尔15mg／kg）和E组（艾司洛尔20mg／kg）。插管前30s分别静注生理盐水10ml,艾司洛尔05mg／kg,10mg／kg,15mg／kg,20mg／kg。记录患者给药前、插管时、插管后1、3、5、10min时的收缩压（SBP）、舒张压（DBP）、心率（HR）,并计算出相应的脉率收缩压乘积（RPP）。结果A组插管时SBP、DBP、HR、RPP及插管后1rainDBP、HR、RPP显著高于给药前（p〈001）;B组插管时DBP、HR、RPP显著高于给药前（P〈001）,插管时及插管后1minSBP、HR、RPP显著低于A组（p〈0．01）;C、D、E3组插管时SBP、DBP、HR、RPP显著低于A、B两组（p〈005）,插管后1rainSBP,HR,RPP显著低于A组（P〈0.01）;插管后3minC、D两组SBP,D、E两组HR,C、D、E3组RPP显著低于A组（p〈0.05）＋D组插管后3～10minHR、RPP,E组插管时及插管后1～10minHR、RPP显著低于给药前（P〈0.05）,但E组有5例用药后发生心动过缓。结论静脉注射艾司洛尔15mg／kg对气管插管时的心血管反应预防效果较好,插管前后血流动力学稳定且副作用发生少。