非正压通气序贯快诱导插管全麻和清醒气管插管全身麻醉用于急诊创伤患者：60例观察

Non-positive pressure ventilation sequential quick induced anesthesia and endotracheal intubation general anesthsia in waking state in treatment of patients with emergency trauma： clinical observation of 60 cases

目的对比两种不同的诱导插管方式用于急诊创伤患者的优劣。方法60例需全身麻醉的急诊创伤手术患者，随机均分为2组：非正压通气序贯快诱导组（甲组），气管插管全麻持续高流量纯氧经面罩预吸，依次静注丙泊酚、芬太尼及罗库溴铵序贯快诱导，和清醒气管插管全身麻醉组（乙组），吸氧后静注咪唑安定镇静，口鼻咽表面麻醉后清醒经鼻盲探或直接喉镜下经口明视气管插管。记录诱导插管时间，插管前、插管成功即刻的血压、血氧饱和度及诱导插管期并发症。结果2组基础血压值相当。插管成功即刻，甲组收缩压和舒张压为（81．8±4．2）mmHg和（61．3±5．6）mmHg，均显著低于清醒插管组[（128．2±8．4）mmHg和（88．2±8．5）mmHg，均P〈0．05]；甲组插管时间为（147．35±19．26）s，显著短于清醒插管组[（189．75±56．26）s，P〈0．05]。甲组1例返流，无误吸；乙组7例呕吐，27例插管期呛咳明显，9例口、鼻腔黏膜损伤出血。结论与清醒插管比，非正压通气序贯快诱导气管插管不但同样可预防急诊创伤患者全麻诱导插管期的返流误吸，而且诱导捅管时问短，插管反应轻，插管损伤等并发疖少．

Objective To compare the superior and inferior of non-positive pressure ventilation sequential quick induced anesthesia and endotracheal intubation general anesthesia in waking state. Methods Sixty patients with emergency trauma needing general anesthesia were randomly divided into 2 groups： Group A undergoing non-positive pressure ventilation sequential quick induced anesthesia by endotracheal intubation, inhalation of pure oxygen, and sequentially intravenous injection of dfentanyl, and diisopropylphenol, and rocuronium bromide, and Group B, undergoing oxygen inhalation, intravenous injection of midazolam, and endotracheal intubation via nose or by direct laryngoscopy under waking state. The induction intubation time, changes of blood pressure, oxygen saturation （O2Sat） and complications were compared between these 2 groups. Results There were not significant differences in baseline blood pressure between these 2 groups. The systolic and diastolic pressures immediately after the successful intubation of Group A were （ 81.8 ±4.2） mmHg and （ 61.3± 5.6） mmHg respectively, both significantly lower than those of Group B [（128.2±8.4） mmHg and （88.2±8.5） mmHg, both P〈0.05]. The intubation time of Group A was （147.35 ± 19.26） s, significantly shorter the that of Group B [（189.75 ± 56.26） s, P〈0.05]. Fewer complications were found in Group A than in Group B. Conclusion Both non-positive pressure ventilation sequential quick induced anesthesia and endotracheal intubation general anesthesia in waking state prevent the regurgitation and pulmonary miss-inhalation in the patients with emergency trauma, and the intubation time is shorter, intubation reaction is milder, and complications are less in non-positive pressure ventilation sequential quick induced anesthesia.