异丙酚靶控输注用于口腔颌面外科盲探插管麻醉的效果评价

Study of propofol target controlled infusion for blind tracheal intubation in anesthesia of oral and maxillofacial surgery

目的:观察异丙酚靶控输注(TCI)用于口腔颌面外科盲探插管麻醉的效果。方法:将80例口腔颌面外科气道困难病例等分为4组,均采用盲探气管插管新技术插管。插管前,组Ⅰ、组Ⅱ、组Ⅲ给予芬太尼4μg/kg,并分别按1.0μg/ml、1.5μg/ml、2.0μg/ml的靶血药浓度实施异丙酚TCI;组Ⅳ仅给予芬太尼4μg/kg。所有患者均用局麻药完善气管内表面麻醉,观察比较4组插管的麻醉效果。结果:组Ⅱ和组Ⅲ的Ramsay镇静评分较用药前明显上升,插管中其分值也显著高于其他组(P<0.05);插管中,组Ⅱ和组Ⅲ的MAP、HR稳定;组Ⅰ和组Ⅳ显著上升(P<0.05);插管中,4组RR均明显下降,其中,以组Ⅲ最为明显(P<0.05),但4组的SpO2、PETCO2均无显著变化;4组的血浆PRL和血浆AⅡ插管后较插管前均有不同程度的明显上升,组Ⅳ升幅明显高于组Ⅲ(P<0.05)。结论:异丙酚靶控输注有助于完善盲探插管麻醉,在控制合适靶血药浓度的前提下,这种方法是安全可行的。

PURPOSE: To observe the clinical effects of propofol target controlled infusion for blind tracheal intubation in anesthesia of oral and maxillofacial surgery. METHODS: 80 cases with difficult airway of oral and maxillofacial surgery were divided into four groups. They were intubated by a new blind tracheal intubation technique.Before intubation,group 1,group 2,group 3 received fentanyl 4μg/kg by intravenous infusion and propofol TCI 1.0μg/ml,1.5μg/ml,2.0μg/ml, respectively.Group 4 only received fentanyl 4μg/kg.All patients underwent tracheal topical anesthesia.The effects of anesthesia in the four groups were observed and compared. RESULTS: Ramsay score in group 2 and group 3 was obviously higher after administer propofol TCI(P<0.05).During intubation, group 2 and group 3 kept higher score than the other groups(P<0.05), MAP and HR changed smoothly and steadily in group 2 and group 3. But in group 1 and group 4, MAP and HR increased significantly(P<0.05). During intubation, RR decreased significantly in the four groups, but most serious in group 3(P<0.05).There were no significant changes of SpO2,PETCO2. After intubation, plasma PRL and plasma AⅡ increased obviously in different degrees in the four groups,the increase in group 4 was higher than in group 3(P<0.05). CONCLUSION: Propofol target controlled infusion is a good anesthesia method for blind tracheal intubation.It is safe and effective if target blood concentration controlled appropriately.