无刺激改良全麻诱导在急诊饱胃患者中的应用

The Application of An Improved Induction of General Anesthesia in Emergency Patients with Full Stomach

目的:观察改良全麻诱导方案在急诊饱胃患者中的应用效果及安全性。方法:ASAⅠ～Ⅲ级、急诊全麻饱胃患者98例,取头高足低位25°,面罩鼻式纯氧吸入;注射利多卡因1mg/kg,静脉阻断30s后继给1.6mg/kg维库溴铵(万可松)并计时,再注射2.5mg/kg异丙酚和125μg/kg麻黄碱,计时110s即行插管,期间不托下颌,插管成功后接机并Pet.CO2手控呼吸。分别于诱导前、插管前和插管成功后记录收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SpO2)和咽部pH值等指标。结果:鼻式纯氧吸入可使90.8%患者SpO2达100%;插管成功率100%,其中1次性成功率94.9%;平均无通气时间(148±24)s;插管后SBP和HR明显高于诱导前和插管前(P<0.05),而诱导前较插管前无差异(P>0.05);全组患者无可见性呕吐,插管前、插管后和手术结束时咽部Ph值无差异(P>0.05);96.9%患者对诱导过程无不良记,5.1%轻微不良记忆。结论:该改良方案可有效减少插管等刺激和胃内反流、提高急诊饱胃麻醉安全性和减少不良记忆。

Objective：To evaluate the effect and feasibility of an improved induction of general anesthesia without any stimulation,which was developed to avoid gastric regurgitation,for emergency patients with full stomach.Methods：98 patients,ASAⅠ～Ⅲ,were induced by an improved way during undergoing general anesthesia with full stomach.Patients,backlying the posture of elevating head with 25 degrees and breathing in oxygen with nasal ventilation,were infused with.1 mg/kg lidocaine.followed by infusion of 1.6 mg/kg Vecuronium Bromide after block the local veins 30 seconds.Starting the clock at beginning of infusion with 2.5 mg/kg propofol plus 125 μg/kg ephedrine were followed.At 110 seconds,tracheal intubation was performed without supporting mandible and as soon as successfully,Pet.CO2 ventilation pattern controlled with hands was performed.SBP,DBP,HR,SpO2 and Ph value of pharyngeal portion were examined just ready induction,before or after tracheal intubation successfully,respectively.Results：90.8%patients’SpO2 were 100%;the rate of successful tracheal intubation was 100% and the time of no ventilation was 148±24 seconds.Compared with before induction or tracheal intubation,SBP and HR were increased significantly（P〉0.05）after tracheal intubation,but there was not remarkably different（P〉0.05） between just ready to induction or before tracheal intubation.No vomiting was found in 98 patients,and the Ph value of sample of pharyngeal portion was not different significantly（P〈0.05）among just ready to induction or before tracheal intubation,as well as after operation.Furthermore,circulating condition of 98 patients were stabilization and 96.9% patients were not recorded any horrible memory while 5.1% patients were found slightly horrible memory.Conclusions：The improved induction of general anesthesia without any stimulation could offer a feasible and effective support to emergency patients under the condition of Gastric filling.