丙泊酚合用不同剂量雷米芬太尼用于非肌松药气管插管的观察

目的通过不同剂量雷米芬太尼的使用,确定普通成人非肌松剂气管插管时的雷米芬太尼的合适剂量。方法66例择期手术病人,插管条件Ⅰ~Ⅱ级,ASAⅠ~Ⅱ级。平均分为3组。各组雷米芬太尼用量分别为2、3、4μg/kg;丙泊酚用量均为2 mg/kg。记录给药完成(T1)、插管后1 min(T2)、插管后4 min(T3)的SpO2(动脉血氧饱和度)、NIBP(无创血压)、HR(心率)。根据面罩控制通气满意度、下颌松弛度、声门状态、病人有否呛咳、体动等评定插管条件。结果1、2、3组插管条件临床可接受的比例分别为50%、82%和100%,1组与2组、3组相比差异均有统计学意义(P<0.05);1组严重呛咳、声门紧闭的发生率明显高于2组和3组(P<0.05)。各组给药前后MAP(平均动脉压)、HR相比差异均有统计学意义(P<0.05),但均在临床可接受范围。结论丙泊酚+雷米芬太尼非肌松剂气管插管的方法可以安全应用于临床,推荐剂量为丙泊酚2 mg/kg+雷米芬太尼3~4μg/kg。

Dosing Study of Remifentanil Combined with Propofol in Tracheal Intubation without the Use of Muscle Relaxants

Objective To determine the bolus dose of remifentanil required for reliable intubating condition when combined with propofol 2 mg/kg only.Methods 66 ASA Ⅰ～Ⅱpatients were randomly divided into 3 groups with 22 patients in each group.The predetermined dose of remifentanil for group 1,group 2,group 3 were 2,3,4 μg/kg respectively.All the patients were premedicate with midazolam 0.03 mg/kg.60 s after propofol 2 mg/kg and the predetermined dose of remifentanil were administered,laryngoscopy and intubation were performed and the intubating conditions were assessed.Results Clinically acceptable intubating conditions were observed in 11 patients in group 1 compared with that in 18 patients in group 2 and all in group 3(P<0.05).The significant but clinically acceptable reduction in mean arterial pressure(MAP) and heart rate(HR) after the administration of the drug were observed in each group(P<0.05).Conclusion Remifentanil 3⁴ μg/kg can reliably provide clinically acceptable intubating conditions when administered after propofol 2 mg/kg.