靶控输注瑞芬太尼改善七氟醚吸入诱导插管条件的临床观察

目的评价靶控输注瑞芬太尼改善七氟醚诱导用于无肌松药气管插管的临床效果。方法将拟行择期手术全身麻醉的患者46例随机分为2组,复合瑞芬太尼组(Ⅰ组)靶控输注1 ng/mL瑞芬太尼,单纯吸入组(Ⅱ组)输注等量生理盐水。进行七氟醚吸入诱导,气体监测仪监测出呼吸末七氟醚达2.5 MAC,稳定3 min后行气管插管。分别记录诱导前(T0)、诱导后插管前(T1)、插管后1 min(T2)、插管后2 min(T3)和插管后5 min(T4)的MAP、HR和SpO2。结果Ⅰ组患者意识消失时间和插管时间显著短于Ⅱ组,Ⅰ组呼气末七氟醚浓度达2.5 MAC时间较Ⅱ组延长(P<0.05)。Ⅰ组插管条件评分优于Ⅱ组(P<0.05)。Ⅰ组诱导后MAP和HR显著下降。Ⅱ组诱导后MAP下降,插管后1 min,MAP、HR较基础值显著升高,与Ⅰ组比较差异有统计学意义(P<0.05)。结论瑞芬太尼1 ng/mL靶控输注复合七氟醚吸入诱导,能较好地控制气管插管的血流动力学反应,在无肌松药条件下,可达到满意的气管插管条件。

Clinical observation of target controlled infusion of remifentanil on tracheal intubation without muscle relaxant after anesthesia induction with sevoflurane

Objective To evaluate the clinical effect of target controlled infusion of remifentanil on tracheal intubation without muscle relaxant after anesthesia induction with sevoflurane.Methods 46 patients scheduled for elective surgery under general anesthesia were randomized into remifentanil group(groupⅠ) and control group(groupⅡ) with 23 cases in each group.GroupⅠ received target controlled infusion of remifentanil with target effect site concentration of 1 ng/mL,while groupⅡ received continous injection of equivalent normal saline.Anesthesia was induced with inhalation of sevoflurane in 100% oxygen.Tracheal intubation was performed after MAC was up to 2.5 and during 3 min.MAP,HR and SpO2 were separately recorded before induction(T0),immediately before intubation(T1),at 1,2 and 5 min after intubation(T2,T3 and T4).Results Consciousness loss time and intubation time in groupⅠwere both shorter than those in groupⅡ(P<0.05).Evaluation of intubation conditions of groupⅠwere superior to that of groupⅡ.HR and MAP significantly decreased at T1 compared with the baseline values before anesthesia at T0 in groupⅠ(P<0.05).MAP decreased at T2 compared with the baseline values before anesthesia at T0 in groupⅡ(P<0.05).MAP and HR in groupⅠat T2 was obviously lower than those in groupⅡ(P<0.05).Conclusion Induction of anesthesia with sevoflurane combined with remifentanil given by TCI with target effect site concentration of 1 ng/mL could provide appropriate tracheal intubation conditions for the patients without muscle relaxant,and it is effective in maintaining the stability of hemodynamic processes.