光导纤维支气管镜与直接喉镜经口气管插管对小儿血流动力学的影响

Hemodynamic Responses to Orotracheal Intubation with Fiberoptic Bronchoscope and Direct Laryngoscope in Children

目的对比观察小儿全身麻醉诱导后采用光导纤维支气管镜(FOB)和直接喉镜(DLS)经口气管插管对血流动力学的影响。方法选择美国麻醉医师协会Ⅰ～Ⅱ级、择期整形外科手术的小儿43例,随机分为DLS组(n=20)和FOB组(n=23),常规静脉麻醉诱导后进行经口气管插管。监测麻醉诱导前后、气管插管时和气管插管后5min内的收缩压(SBP)、舒张压(DBP)、心率(HR)和心率收缩压乘积(RPP)的变化。结果DLS组气管插管时的SBP、HR和RPP比麻醉诱导后显著升高(P<0.05),但气管插管时的血压、HR和RPP与麻醉诱导前相比差异无显著性,观察期(从静脉麻醉诱导开始至气管插管后5min为止)内SBP、HR和RPP的最大值显著高于麻醉诱导前(P<0.05)。FOB组气管插管时的血压、HR和RPP比麻醉诱导前和麻醉诱导后显著升高(P<0.05),观察期血压、HR和RPP的最大值显著高于麻醉诱导前(P<0.05)。观察期各对应时间点的SBP和RPP两组间差异无显著性。气管插管时的HR在FOB组显著高于DLS组(P<0.05),但观察期内其他各时间点的HR两组间差异无显著性。观察期血压和HR的最大值及其达最大值的时间两组间差异无显著性。结论临床常用的全身麻醉深度不能有效抑制FOB经口气管插管在小儿引起的加压反应和心率增快反应。与DLS相比,FOB在预防小儿经口气管插管的心血管系统应激反应方面无明显优越性。

Objective To compare the hemodynamic responses to orotracheal intubation Via fiberoptic bronchoscope （FOB）with conventional orotracheal intubation via direct laryngoscope （DLS） in children under general anesthesia. Methods Forty-three American Society of Anesthesiologist grade Ⅰ-Ⅱ children undergoing the elective plastic surgery and requiring orotracheal intubation were randomly allocated to either the DLS group（n = 20）or the FOB group （n = 23）. After standard intravenous anesthetic induction,orotracheal intubation was performed using a DLS or a FOB. Noninvasive systolic blood pressure （SBP）, diastolic blood pressure（DBP）, heart rate （HR）, and rate-pressure product （RPP） were recorded before and after anesthetic induction, at intubation, and 5 minutes after intubation with 1 minute interval. Results In the DLS group, SBP, HR, and RPP at intubation increased significantly compared to their postinduction values （P 〈 0.05）,but blood pressure, HR and RPP at intubation didn＇t differ from their preinduction values. The maximal values of SBP, HR and RPP during the observation （from the beginning of intravenous anesthetic induction to 5 minutes after intubation） were significantly higher than their preinduction values （P 〈 0.05）. In the FOB group, blood pressure, HR and RPP at intubation increased significantly compared to their preinduction and postinduction values （P 〈 0.05）, and the maximal values of blood pressure, HR and RPP during the observation were significantly higher than their preinduction values （P 〈 0.05）. There were no significant differences in blood pressure and RPP at each time point during the observation between the two groups. The HR at intubation were significantly higher in the FOB group than in observed in the HR values at other time points the DLS group （P 〈 0.05）, but no significant difference was during the observation between the two groups. There were also no significant differences in the maximal values of blood pressure, HR and RPP or the times to reach their maximal values between the two groups. Conclusion General anesthesia of clinical standard depth can not effectively inhibit the pressor and tachycardiac responses caused by fiberoptic orotracheal intubation in children. As compared with DLS, FOB has no special advantages in preventing the cardiovascular stress responses to orotracheal intubation in children.