不同药物配伍用于双腔支气管插管全麻诱导的临床研究

目的探讨双腔支气管插管全麻诱导的最佳药物配伍。方法拟施行胸外科择期手术需双腔支气管插管患者80例，ASAⅠ-Ⅱ，分为A、B两组，A组采用咪达唑仑、芬太尼、丙泊酚、阿曲库铵静脉诱导插管；B组以舒芬太尼替代芬太尼，其余同A组。分别记录两组麻醉诱导前（Tn）、注药后插管前即刻（T1）、双腔支气管插管后即刻（T2）、插管后1min（T3）、3min（T4）和5min（T5）各时点的收缩压（SBP）、舒张压（DBP）、心率（HR）值。结果两组患者Tn时SBP、DBP、HR（124．9±16．0）mmHgvs（125．8±6．4）mmHg、（73．1±9．9）mmHgVS（74．3±10．4）mmHg、（81．8±6．6）次／minvs（82．4±8．1）次／min]组间比较差异无统计学意义（P〉0．05）。诱导后T1两组（94．8±10．03）mmHgvs（96．9±10．1）mmHg、（57．3±7．66）mmHgvs（55．4±7．03）mmHg、（69．6±7．43）次／minvs（66．3±7．03）次／min]患者与T0比较各指标均显著降低（P〈0．05）。插管后T2-T4各时点A组各指标SBP：（146．3±14．2）mmHg、（141．2±10．63）mmHg、（137．2±13．23）、（122．9±11．6）mmHg；DBP：（94．9±10．6）mmHg、（84±9．63）mmHg、（79．9±9）mmHg、（75．8±8．3）mmHg；HR：（102±10．63）次／min、（97．6±9．23）次／min、（87．7±8．2）次／min、（82．1±7．32）次／min]与基础值比较均明显升高（P〈0．05），B组SBP：（130±11．6）mmHg、（125．6±10．43）mmHg、（120．1±12．3）mmHg、（116．8±11．4）mmHg；DBP：（75．6±9．12）mmHg、（76．2±9．8）mmHg、（73．1±9．2）mmHg、（71．6±8．46）mmHg；HR：（88±9．12）次／min、（82．9±7．5）次／min、（81．9±8．2）次／min、（79．9±7．8）次／min]虽也升高但与基础值相比差异无统计学意义（P〉0．05）。组间比较T2～T4点的A组SBP、DBP、HR明显高于B组（P〈0．05）。结论舒芬太尼诱导行双腔支气管插管抑制插管心血管反应的作用强于芬太尼，期间血流动力更稳定，值得推广。

Study on the best drug compatibility for the double-lumen endobronchial intubation anesthesia

Objective Study on the best drug compatibility for the double-lumen endobronchial intubation anesthesia. Methods Eighty ASA Ⅰ - Ⅱ patients undergoing selective thoracis surgery requiring intubation with double-lumen tubes were randomly divided into A and B group, with 40 cases in each group.The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), were recorded before induction (T0) , after drug injection (T1), during intubation (T2), and at 1 min (T3), 3 min (T4)and 5 min (T5) after intubation. Results There was no significant difference in SBP, DBP and HR between the two groups at T0(124. 9 ± 16. 0) mmHg vs (125.8 ±6. 4) mmHg, (73. 1 ±9. 9)mmHg vs (74. 3± 10. 4) mmHg, (81.8 ± 6. 6) times/min vs (82. 4 ± 8. 1) times/min] (P ＞ 0. 05). Compared with parameter at T0, SBP, DBP and HR, parameters in two groups in T1 were all significantly decreased after anesthesia (94. 8 ± 10. 03) mmHg vs (96. 9 ± 10. 1) mmHg, (57. 3 ± 7. 66) mmHg vs (55.4 ± 7. 03) mmHg,(69. 6 ± 7. 43) times/min vs (66. 3 ± 7. 03) times/min] (P ＜ 0. 05). The cardiovascular parameters at T0,T2, T3, T4 were all comparable with those in group B SBP: (130 ± 11.6) mmHg, (125.6 ± 10. 43) mmHg,(120. 1 ± 12. 3)mmHg,(116. 8± 11.4)mmHg;DBP:(75.6 ±9. 12)mmHg,(76. 2 ±9. 8)mmHg,(73. 1 ±9. 2) mmHg, (71.6 ± 8.46) mmHg; HR: (88 ± 9. 12) times/min, (82. 9 ± 7.5) times/min, (81.9 ± 8.2)times/min, (79. 9 ± 7. 8) times/min] (P ＞ 0. 05) , which were significantly higher than those in group A SBP: (146. 3 ± 14. 2) mmHg, (141.2 ± 10. 63) mmHg, (137. 2 ± 13.23) mmHg, (122. 9 ± 11.6) mmHg;DBP: (94. 9 ± 10. 6) mmHg, (84 ± 9.63) mmHg, (79. 9 ± 9) mmHg, (75.8 ± 8. 3) mmHg; HR: (102 ±10. 63) times/min, (97.6 ± 9. 23) times/min, (87. 7 ± 8. 2) times/min, (82. 1 ± 7.32) times/min] (P ＜0. 05). The parameters at T2, T3, T4 in group A were obviously higher than those group B (P ＜ 0. 05).Conclusions Cardiovascular response with double-lumen endobronchial intubation by sufentanil-induced was stronger than fentaty, sufentanil had more stable hemodynamic parameters and it worth to be usd in clinic.