芬太尼或瑞芬太尼复合异丙酚静脉麻醉用于经鼻盲探气管插管的可行性研究

目的探索芬太尼或瑞芬太尼复合异丙酚静脉麻醉用于经鼻盲探气管插管的安全性及有效性。方法ASAⅠ-Ⅱ级拟在全身麻醉气管插管下行择期手术的患者80例，年龄18～64岁，以芬太尼2μg／kg或瑞芬太尼1μg／kg、异丙酚2mg／kg静脉诱导后随机分为4组，每组20例：异丙酚4mg／（kg·h）（P4）组、异丙酚6mg／（kg·h）（P6）组、异丙酚8mg／（kg·h）（P8）组和异丙酚4mg／（kg·h）＋瑞芬太尼5μg／（kg·h）（R）组，微量泵持续静脉注射，行经鼻盲探气管插管。观察各组患者麻醉诱导插管过程中循环、呼吸（MAP、DBP、SBP、HR、ECG、RR和SPO2）改变及盲探气管插管的第1次成功率；记录插管过程中知晓发生率和后鼻孔损伤出血等并发症。结果各组循环稳定，但P8、R组插管时循环变化较小，R组插管时部分患者HR较慢；各组呼吸均有不同程度抑制，但P8、R组最明显，R组呼吸频率明显低于其它3组，吸氧后各组SPO2均能维持正常；P8、R组盲探气管插管的第1次成功率明显高于其它2组。结论芬太尼复合异丙酚静脉麻醉较瑞芬太尼复合异丙酚静脉麻醉用于经鼻盲探气管插管更安全、可靠，诱导后异丙酚维持量以8mg／（kg·h）为宜。

Blind Nasotracheal Intubation under Intravenous Fentanyl-propofol Anesthesia or Intravenous Remifentanil-propofol Anesthesia

Objective To study the safety and efficacy of blind nasotracheal intubation under intravenous fentanyl-propofol anesthesia or intravenous remifentanil-propofol anesthesia. Methods Eighty patients with ASA Ⅰ -- Ⅱ aged 18-64 year undergoing elective surgical operations after intravenous anesthesia and endotracheal intubation（fentanyl 2 μg/kg or remifentanil 1 μ/kg, propofol 2 mg/kg） were randomly divided into four groups with 20 in each group, group P4 ,P6, Ps and R [propofol 4 mg/（kg · h）, 6 mg/（kg · h）,8 mg/（kg · h） and 4 mg/（kg · h）＋remifentanil 5 μg/（kg · h）]. All patients were intubated through blind nasotracheal intubation. MAP. DBP.SBP. HR.ECG.RR and SPO2 were monitored during induction of anesthesia and blind nasotracheal intubation; The first time success rate of blind nasotracheal intubation was recorded and compared among the four groups. Results The changes of circulation were significantly smaller in group P8 and R than that in group P, and P4 ; The inhibition of breathing was existing in four groups, and most obvious in group P8 and R than that in group P6 and P4. The breathing rate was significantly lower in group R than that in group P8 ,P6 and P4 ,but SPO2 in four groups recovered well after oxygen inhalation. The first time success rate of blind nasotracheal intubation was significantly higher in group P8 and R than that in group P6 and P4. Conclusion Intravenous fentanyl-propofol anesthesia could be applied more safely and effectively to the blind nasotracheal intubation and the dose of propofol should be maintanced at 8 mg,after induction.