老年患者七氟烷复合瑞芬太尼诱导插管的临床研究

目的：观察老年患者应用七氟烷复合瑞芬太尼诱导插管时对气管插管条件及血液动力学的影响。方法：将40例ASAⅠ～Ⅱ级、年龄〉60岁的老年患者,随机双盲进入2种剂量的瑞芬太尼组。诱导前10min静注阿托品0.5mg。用潮气量法自主呼吸,吸入8%七氟烷,100%氧气流量6L/min。诱导开始后2min,两组患者分别静脉注射瑞芬太尼1μg/kg（Ⅰ组）或2μg/kg（Ⅱ组）。1min后停止七氟烷吸入,置入喉镜,插入7.5号气管导管。确认插管成功后,用七氟烷维持麻醉。最佳气管插管条件为下颌骨完全放松,局部或完全声门开放,插管时无咳嗽。良好气管插管条件为下颚部分松弛、气管插管后有轻微咳嗽。结果：两组患者均成功完成气管插管,无并发症出现。意识消失的平均时间Ⅰ组48s,Ⅱ组46s。成功气管插管的平均时间Ⅰ组31s,Ⅱ组30s。插管后咳嗽发生率,Ⅰ组为35%,Ⅱ组为10%,两组比较,差异有统计学意义（P〈0.05）。两组中具备最佳插管条件的患者,Ⅰ组为60%、Ⅱ组为90%,两组比较,差异有统计学意义（P〈0.05）。良好加上最佳插管条件的患者比率更高,Ⅰ组为95%,Ⅱ组为100%。发生低血压,Ⅰ组为15%,Ⅱ组为35%,但低血压持续时间短,可通过对症处理使血压平稳。结论：七氟烷复合瑞芬太尼可安全用于老年患者的麻醉诱导,瑞芬太尼的最佳气管插管剂量是2μg/kg。

Clinical research of Sevoflurane and Remifentanil used for induced intubation in the elder patients

Objective： To observe the effect of tracheal intubation and hemadynamics of Sevoflurane and Remifentanil used for induced intubation in the elder patients. Methods： 40 cases of elder patients （ASAⅠ-Ⅱ, age60） were divided into two groups according to different doses of Remifentanil. Before 10 minutes of anesthetic induction, all patients were given 0.5 mg of Atropine to counteract the bradycardic effects of Remifentanil, and with 8% Sevoflurane, 100% oxygen of 6 L/ min. After two minutes, the patients were given to Remifentanil 1 μg/kg （group Ⅰ） or 2 μg/kg （group Ⅱ）. After 1 minute, tra cheal intubation was initiated, laryngoscope was used used the 7.5-0 of tracheal intubation, then Sevoflurane was to sustain anaesthesia. Conditions for tracheal intubation, the best contained mandible reflex, glottis open full or not full and no cough of intubation; the better contained not full of mandible reflex and slightly cough of intubation under the intubation. Results： Tracheal intubation was successful in all patients, no complication. The average disappeared time of consciousness in group Ⅰ was 48 s and 46 s of group Ⅱ. The time of successful intubation were 31 s and 30 s in group Ⅰ and group Ⅱ. There was a significant difference about cough rate in group Ⅰ（35%） and group Ⅱ （10%） （P0.05）. There was a signif icant differece about the best tracheal intubation condition in groupⅠ（60%） and in group Ⅱ（90%） （P0.05）. The ratio of best and better was higher, there was a significant difference in group Ⅰ（95%） and group Ⅱ （100%）. However, 35% of the group Ⅱ resulted in a greater decrease in mean arterial pressure than 15% of group Ⅰ, but the time was shorter, could be controlled. Conclusion： Sevoflurane and Remifentanil are safe for induced intubation in the elder patients, the optimal intubation dose of Remifentanil is 2 μg/kg.