芬太尼复合丙泊酚用于全麻患者喉罩置入时的临床效果

Clinical effect of fentanyl in the insertion laryngeal mask airway

目的探讨芬太尼复合丙泊酚用于全麻患者喉罩置入时的临床效果。方法将60例需全麻手术、适合使用喉罩、ASAⅠ-Ⅱ级、年龄18-65岁的患者分为两组:单纯丙泊酚组(P组,n=30)静脉注射丙泊酚2.5mg/kg;丙泊酚+芬太尼组(PF组,n=30)静脉注射丙泊酚2.5mg/kg+芬太尼1μg/kg。诱导后置入喉罩。记录患者用药前、用药后1min、喉罩置入后1min的HR(心率)和MAP(平均动脉压)以及评估喉罩置入条件的6项指标(张口困难分级、置入喉罩困难分级、吞咽反射、干咳干呕反射、肢动反应及喉痉挛分级),同时记录患者呼吸暂停时间。结果PF组能提供更好的喉罩置入条件,且能减少吞咽反射和肢动反应的发生,同时更能保证喉罩置入时血流动力学的稳定,但会延长呼吸抑制时间。结论芬太尼复合丙泊酚能为全麻患者喉罩置入时提供更好的条件且能保证更好的血流动力学稳定。

Objective To determine the clinical effect of fentanyl in laryngeal mask airway insertion. Methods Sixty adult ethnic Chinese patients aged 18 - 65 yrs, with an American Society of Anesthesiologists physiologic status classification Ⅰ or Ⅱ and requiring general anesthesia for elective surgery with a laryngeal mask were recruited. They were randomly assigned to two groups（n =30） ：Group P received propofol 2. 5mg/kg before the insertion laryngeal mask airway, Group PF received propofol 2. 5mg/kg and fentanyl 11μg/kg before the insertion laryngeal mask airway. The patients mean blood pressure and heart rate were recorded before induction, 1 min after induction, and 1 min after LMA insertion. Insertion conditions were assessed using a six - category score （ Resistance to mouth opening grading, Resistance to insertion grading, Swallowing grading, Coughing and gagging grading, Head or body movement grading, Laryngospasm grading）. The duration of apnea was recorded. Results The median （ interquartile range ） summed insertion scores were more favourable in Group PF 8. 0 [ 7.0 - 10.0 （ 6.0 - 15.0） ] than in Group P 10.0[7.8 - 12. 3（6.0 - 18.0） ], Group PF decreased swallowing and head or limb move- ment and improve the hemodynamics stability, while prolonged apnoea. Conclusion Fentanyl is effective in facilitating insertion of the laryngeal mask airway and improving the hemodynamics stability following anaesthetic induction with propofol.