力月西与芬太尼在经鼻盲探气管插管中的应用

目的　探讨力月西与芬太尼在病人半清醒状态下经鼻盲探气管插管中的作用。方法　选择张口受限患者 4 0例 ,经鼻盲探气管插管前静脉注射力月西 0 0 5～ 0 1mg/kg、芬太尼 1～ 2 μg/kg体重 ,2 %利多卡因 2mL环甲膜穿刺 ,1%丁卡因 0 5mL喷鼻腔行鼻黏膜局部麻醉 ,待病人意识模糊 ,呼之能应并能配合呼吸时 ,借助病人呼吸气时气流声音或在光导索的引导下进行气管插管 ,气管插管成功后立即静脉注射力月西、异丙酚、阿曲库铵增加麻醉深度。结果　在病人半清醒状态下进行经鼻盲探气管插管时 ,恰当的使用力月西和芬太尼 :①可以使病人在插管时保持镇静、镇痛效果 ;②术后 87 5 %的病人对插管完全遗忘 ,2 5 %的病人不完全记忆 ,仅 1%的病人不产生遗忘 ;③诱导后与基础值相比血压下降显著 (P <0 0 5 ) ,心率无明显变化(P >0 0 5 ) ,插管后血压回升 ,但与基础值无明显差异 (P >0 0 5 )。结论　力月西和芬太尼联合应用于半清醒状态下经鼻盲探气管插管中 ,可以有效减轻病人插管时的痛苦和术后对病人精神上的不良刺激 ,并可以减轻插管时病人循环系统的波动

Application of Liyuexi and Fentanyl during Blind Tracheal Intubation via Nasal Cavity

Objective To discuss the action of liyuexi and fentanyl during blind tracheal intubation via nasal cavity at hemi-wakefulness. Methods 40 cases of chasmodes patient were received such intubation. The liyuexi and fentanyl were injected before intubation with local anesthesia of lidocaine at cricothyroid membrane puncture and nasal cavity anesthesia with dicaine. Results The appropriate use of liyuexi and fentanyl could keep sedation and analgesia effect during intubation. 87.5% patient had complete amnesia of intubation after operation. 2.5% patient had incompletely memory and 1% had no amnesia. There was different significance of blood pressure decrease after induce and their basic pressure (P<0.05) without changes of heart rate. The blood pressure elevated after intubation. Conclusion The application of liyuexi and fentanyl during tracheal intubation via nasal cavity could reduce the pain and poor stimuli on mind after intubation and could reduce the affection for circulatory system.