背景输注瑞芬太尼对纤支镜清醒气管插管反应的影响

Effects of background infusion of remifentanii on the response to intubation

目的:探讨背景输注瑞芬太尼对光导纤维支气管镜(FOB)引导下经鼻清醒气管插管反应的影响。方法:困难气道病人21例,ASA分级Ⅰ或Ⅱ级,随机分为瑞芬太尼组(R组)11例和对照组(C组)10例。两组气管插管操作前15 min均静脉注射咪唑安定0.03 mg/kg,1%丁卡因5 ml作鼻腔至气管的表面麻醉,R组同时持续输注瑞芬太尼0.1μg/ (kg·min)。记录给药、插管过程中的HR、MAP、SpO_2、警觉/镇静(OAA/S)评分和FOB插管评分。结果:插管过程中SpO_2无显著变化。与C组相比较:R组导管插入时及插管后1 min MAP较低;FOB暴露声门时、导管插入时及插管后1 min HR较低;OAA/S评分、FOB插管评分下降。结论:背景输注瑞芬太尼0.1μg/(kg·min)可减轻FOB引导下经鼻清醒气管插管病人的插管反应,安全可行。

Objective ： To evaluate the effects of background infusion of remifentanil on response to intubating fiberoptic bronchoscope （FOB） through nasal route when the patient was in conscious state. Methods ： 21 patients, ASA Ⅰ or Ⅱ, with predictably difficult airways, were randomly divided into control group （ n - 10） and remifentanil group （ n - 11 ）. Midazolam as premedication was given intravenously with a dose of 0.03 mg/kg 15 rain before nasal fiberoptic intubation was carried out and superficial anesthesia from nasal cavity to upper trachea with 1% dicaine 5 ml were administered to both two groups. Apart from the prescribed medication, remifentanil group received continuous remifentanil infusion simultaneously at 0.1 μg/（kg·min）. HR, BP, SpO2,FOB intubation score and OAA/S score of each patient were recorded before intubation （baseline） and 1 rain after intubation. Results： No SpO2 changes were observed during the procedure, but MAP was significantly lower in remifentanil group than that in control group immediately and 1 rain after intubation. When compared with control group, HR was significantly lower in remifentanil group during induction of anesthesia, immediately and 1 min after intubation. The FOB intubation score and OAA/S score marked evidently lower in remifentanil group in comparison with control group during induction and intubation. Conclusion ： Administration of background infusion of remifentanil at 0. 1 μg/ （kg·min） is a safe remedy for fiberoptic intubation by inhibiting response to awake intubation.