右美托咪定复合七氟醚和瑞芬太尼在甲状腺肿瘤患者无肌松药气管插管中的应用

目的评价右美托咪定复合七氟醚及瑞芬太尼麻醉诱导在甲状腺肿瘤患者无肌松药气管插管中的应用价值。方法甲状腺肿瘤患者40例，麻醉诱导前15min静脉注射右美托咪定0．5μg／kg，10min注射完毕，以七氟醚和瑞芬太尼进行麻醉诱导。记录诱导前（T0）、插管即刻（T1）、插管后1min（T2）及插管后3min（T3）时平均动脉压、心率及Narcotrend指数，记录睫毛反射消失时间，采用VibyMogensen评分法评价气管插管条件。结果睫毛反射消失时间（76±6）s，一次气管插管成功率为97％，气管插管条件优良率100％；与T0时比较，T1、T2时平均动脉压、心率及Narcotrend值明显降低（P〈0．05），T3时平均动脉压及Narcotrend值明显降低（P〈0．05）；T1、T2、T3时平均动脉压、心率及Narcotrend值比较差异无统计学意义（P〉0．05）。结论右美托咪定复合七氟醚及瑞芬太尼麻醉诱导迅速而平稳，可提供良好的气管插管条件，用于甲状腺肿瘤患者无肌松药气管插管安全可行。

Application of dexmedetomidine-sevoflurane-remifentail in tracheal intubation without muscle relaxants in thyroid tumor

Objective To evaluate the application value of induction with dexmedetomidine-sevoflurane-remifentail to tracheal intubation without muscle relaxants in thyroid tumor. Methods Forty patients with thyroid tumor were intravenously injected dexmedetomidine 0.5 μg/kg within 10 minutes followed by anesthesia induction with sevoflurane and remifentail 15 minutes later. The mean arterial pressure （MAP）, heart rate （HR） and Narcotrend index were monitored and recorded at the time points of pre-administration （T0）, at the beginning of intubation （T1）, one minute after intubation （T2） and three minutes after intubation （T3）. The time of disappearance of eyelash reflex was recorded. The intubation condition was evaluated using Viby Mogensen score. Results The time of disappearance of eyelash reflex was （76±6） seconds. The successful rate of intubation at the first attempt was 97%. The excellent rate of intubation was 100%. The values of MAP, HR and Narcotrend index were lower at T1 and T2 than those at T0 （P〈0.05）. The MAP and Narcotrend index decreased significantly at T3 （P〈0.05）. The values of MAP, HR and Narcotrend index showed no significant difference at T1 , T2 and T3 （P〈0.05）. Conclusion Induction with dexmedetomidine-sevoflurane- remifentail is rapid and smooth, which provides a good condition for intubation and can be safely applied to tracheal intubation without muscle relaxants in thyroid tumor.