依托咪酯与异丙酚在OSA气管插管应用中的比较

【目的】比较使用托咪酯或异丙酚麻醉诱导在阻塞性睡眠呼吸暂停（OSA）患者纤维支气管镜引导经鼻气管插管可行性和安全性。【方法】择期行悬雍垂腭咽成形术（UPPP）的OSA患者30例，随机分成依托咪酯o．2mg／kg（E组）和异丙酚2mg／kg（P组）麻醉诱导两组。利多卡因行鼻至气管上段表面麻醉，静脉推注2μg／kg芬太尼和依托咪酯或异丙酚，意识消失后经纤维支气管镜引导下经鼻气管插管，插管成功后查动脉血气及测呼吸末二氧化碳（PETCO2）。监测脑双频指数（BIS）、血压、心率、血氧饱和度。同时记录患者意识消失、自主呼吸恢复时间、达到最低BIS值的时间及动脉血气乳酸（LAC）值。【结果】两组皆完成纤维支气管镜引导经鼻气管插管，血压、心率、意识消失时间、最低BIS值、LAC值及PETCO2值差异无显著性，E组自主呼吸恢复时间及达到最低BIS值时间[（47．1±11．4）s，（33．8±9．6）s]显著短于P组[（89．8±17．5）S，（61．7±16．3）s（P〈0．01）]。【结论】两组皆完成OSA纤维支气管镜引导经鼻气管插管，但使用依托咪酯全麻诱导时呼吸恢复时间显著快于畀丙酚，故在OSA患者麻醉诱导时使用依托咪酯比异丙酚更安全。

Comparison Between Etomidate and Propofol for Fibreoptic Intubation for Obstructive Sleep Apnea Patients

[Objective] To compare the possibility and safety between etomidate and propofol for nasotracheal fibreoptic intubation for obstructive sleep apnea（OSA） during induction of anesthesia. [Methods] Thirty ASAⅠ-Ⅱ OSA patients scheduled for uvulopalatopharyngoplasty（UPPP） were randomly divided into group E and group P. For induction, 0. 2mg/kg etomidate was used in group E and 2mg/kg propofol was used in group P. All patients were administered lidoeaine for superficial anesthesia from nasal cavity to upper trachea. After intravenous injection of 2ug/kg fentanyl and etomidate or pmpofol, all patients were intubated with nasotracheal fibreoptic after loss of consciousness, Lactic acid （LAC） and PETCO2 were monitored. Bispectral index of cerebral （BIS）, blood pressure, heart rate and arterial oxygen saturation were also monitored. The time of loss of consciousness, time of recovery of spontaneous breathing, the lowest BIS value, time of the lowest BIS value and LAC value were measured. [ResultslAll OSA patients were successfully achieved nasotracheal fibreoptic intubation. Blood pressure, heart rate, the time of loss of consciousness, the lowest BIS value, LAC value and PETCO2 value did not differ. The time of recovery of spontaneous breathing differed significantly. The time of recovery of spontaneous breathing for etomidate （E group） and propofol （P group） was（47.1 ± 11.4） and （89. 8±17.5）s, respectively（ P 〈0. 01）. The time of the lowest bispectral index values differed significantly. The time of the lowest bispectral index values for etomidate and propofol was （33. 8±9. 6） and （61.7±16. 3）s, respectively （ P 〈0. 01）. [Conclusion] Nasotracheal fibreoptic intubation is achieved for OSA patients, but etomidate is considered sa fer, because the time of recovery of spontaneous breathing is faster.