七氟醚与丙泊酚辅助镇静在纤支镜经口气管插管中的比较

目的 在咽喉部表面麻醉+环甲膜穿刺下,比较七氟醚与丙泊酚对纤维支气管镜(FOB)经口气管插管提供辅助镇静的临床效果.方法 选取麻醉前访视怀疑有困难插管的拟全麻患者60例,随机分成七氟醚组(n=30,S组)和丙泊酚组(n=30,P组).局麻后采用辅助镇静,待病人意识丧失后,行FOB操作.记录镇静诱导时间、肢体运动、舌后坠、气管插管时间、一次成功率及插管呛咳情况;术后满意度调查采用VAS评分;监测心电图、动脉血压、SpO2.记录时间点:给药前基础值(T0)、睫毛反射消失时(T1)、插管前(T2)、插管后即刻(T3).结果 两组患者均获成功,操作期间未见明显并发症,无退出病例.S组镇静时间明显长于P组(P＜0.05),而插管时间、一次成功率两组基本相似(P＞0.05),S组镇静诱导期出现肢体运动、插管呛咳的例数明显多于P组(P＜0.05),而舌后坠则明显小于P组(P＜0.05).术后满意度调查VAS评分,S组小于P组(P＜0.05).在T1-3,S组HR高于P组(P＜0.05);在T2,S组MAP高于P组(P＜0.05).结论 两种辅助镇静方式皆可获满意安全的临床效果;丙泊酚提供更好更快的气管插管条件,患者满意度高,血流动力学稳定;而七氟醚则可提供更为安全的气道.

Comparison between adjunctive sedation of sevoflurane and propofol in fiberoptic bronchoscopic oral trachea cannula

Objective To make comparison between the adjunctive sedation of sevoflurane and propofol in fiberoptic bronchoscopic（FOB）oral trachea cannula under topical anesthetia of pars laryngea pharyngis and thyrocricoid puncture.Methods Sixty patients,who were suspected at risk in the intubation in the interview before anesthetizing,were randomly divided into sevoflurane group（n=30,S group）and propofol group（n=30,P group）.After local anesthesia,adjunctive sedation was used.After the patients lost consciousness,FOB was carried out.The sedation induction time,body movement,glossoptosis,time of trachea cannula,success rate of first attempt and bucking caused by intubation were recorded.Visual analogue scale（VAS）scoring was used in the postoperative satisfaction questionnaire.The electrocardiogram,arterial blood pressure and SpO2 were monitored.The changes of above indexes were observed at the time points before administration（T0）,when the eyelash reflex disappeared（T1）,before intubation（T2）and immediately after intubation（T3）.Results All cases were successful.No obvious complication occurred during the operation,and no case withdrew.The sedation time of S group was obviously longer than that of the P group（P0.05）.Time of tracheal intubation and success rate of first attempt in the two groups were similar（P0.05）.In S group,the cases with body movement and bucking in the sedative induction period were more than those in P group（P0.05）,but the cases with glossoptosis were fewer than those in P group（P0.05）.The VAS score of S group was smaller than that of P group（P0.05）.HR of S group at T1-3 were higher than that of P group（P0.05）.MAP at T2 was higher than that of P group（P0.05）.Conclusion Two methods can achieve satisfactory and safe clinical effects.Propofol provides better intubating conditions and faster intubation time,with stable haemodynamics and high satisfaction of patients,while sevoflurane can provide a more secure airway.