瑞芬太尼恒速注射镇痛与表面麻醉下清醒气管插管在困难插管患者中的应用

Awake Fibreoptic Intubation Under Combination of Remifentanil Speed-controlled Infusion for Sedation and Superficial Anesthesia in Patients with a Difficult Airway

目的:探讨注射瑞芬太尼与表面麻醉在困难插管患者中的安全性和效果。方法:将32例有困难插管指征的患者随机分为两组,一组(表面麻醉组)以咪唑安定2mg注射,再以1%丁卡因5ml和2%利多卡因10ml作鼻腔至气管的表面麻醉;二组(瑞芬太尼组)在一组的基础上,加用瑞芬太尼0.1μg/kg.min恒速注射。分别记录两组患者在诱导前、诱导后的HR、SP、DP、MAP、SpO2的变化和VAS评分。结果:两组均能顺利完成气管插管,插管过程SpO2均无显著变化,一组的血流动力学变化显著大于二组,VAS评分也大于二组,两组比较有显著性差异。结论:瑞芬太尼恒速注射镇痛辅助表面麻醉下能显著减轻清醒状态下气管插管的心血管反射,能安全地用于困难插管的患者。

Objective： To evaluate the effect and safety of combination of remifentanil speed -controlled infusion for sedation and superficial anesthesia during awake fiberoptic intubation in patients with a dimcult airway. Method： 32 patients with predictably difficult airways were divided into two groups randomly. Group A ： After intravenous injection of midazolam and superficial anesthesia from nasal cavity to tracheary with 1% dicaine 5ml and 2% lidocaine 10ml, nasal fiberoDtic intubation was carried out. Group B ： on the base of themethod mentioned above, speed - controlled infusion of remifentanil （ 0.1 μg/kg/min ） was employed before intubation. HR, SP, DP, MAP, SpO2 and VAS of each patient before and after induce were recorded. Result： All patients were successfully intubated using the regimen we have described. The changes of hemody- namics and VAS in group A were more significant than that in group B. No SpO2 changes were observed dur- ing the procedure. Conclusion： Combination of remifentanil speed - controlled infusion for sedation and su- perficial anesthesia was a safe regimen for fiberoptic intubation and shown to significantly lessen cardiovascu- lar reflex during the period of intubation.