七氟烷复合瑞芬太尼或舒芬太尼用于无肌松药气管插管的可行性

Efficacy of induction with sevoflurane combined with remifentanil and sufentanil for tracheal intubation without muscle relaxants

目的观察不使用肌松药的情况下七氟烷复合瑞芬太尼或舒芬太尼诱导行气管插管的插管效果以及对血流动力学的影响,评价其可行性。方法择期全麻手术患者50例,ASAⅠ～Ⅱ级,年龄20～60岁,体质量45～75 kg,随机分为两组(n=25):七氟烷复合瑞芬太尼组(R组)和七氟烷复合舒芬太尼组(S组)。麻醉诱导:两组均调节七氟烷挥发罐刻度致8%,氧流量6 L/min,指导患者肺活量法面罩吸入七氟烷,待患者睫毛反射消失时,R组患者静脉注射瑞芬太尼2.0μg.kg-1,S组患者静脉注射舒芬太尼0.4μg.kg-1,两组均在60 s内缓慢注射。注射完毕60 s后,关闭七氟烷挥发罐,气管插管后行机械通气。于给药前、睫毛反射消失时、气管插管前即刻以及气管插管后的即刻、1 min、3 min和5 min,分别记录MAP、HR和BIS值;记录从开始吸入七氟烷到睫毛反射消失的时间及从开始吸入七氟烷到气管插管的时间;记录呼气末七氟烷浓度;评价气管插管条件。结果所有患者均完成气管插管,气管插管成功率为100%,其中R组满意率为88%,S组满意率是96%,两组间满意率差异无统计学意义。两组在注射瑞芬太尼和舒芬太尼后MAP和HR均下降;与气管插管前即刻比较,R组气管插管后各时点MAP下降(P<0.01),而S组MAP变化无统计学意义。两组气管插管前、后BIS值维持于40～60,各时点组间差异无统计学意义。结论七氟烷复合瑞芬太尼或舒芬太尼均能提供良好的气管插管条件,且血流动力学平稳,适用于患者无肌松药条件下气管插管。

Objective To evaluate the efficacy of induction with sevoflurane combined with remifentanil and sufentanil for tracheal intubation without muscle relaxants.Methods Fifty ASA ⅠorⅡ patients,aged 20-60 yr,weighing 45-75 kg,were randomly divided into 2 groups（n=25 each）： remifentanil group（group R） and sufentanil group（group S）.Anesthesia was induced with inhalation of 8% sevoflurane in 100% oxygen.Sevoflurane was inhaled initially with high-flow oxygen（6L/min）.When the patient＇s eyelash reflex disappeared,remifentanil 2.0 ug·kg-1 in group R and sufentanil 0.4 ug·kg-1 in group S was respectively injected slowly over 1 min.60s later sevoflurane inhalation was then stopped.The patients were mechanically ventilated after tracheal intubation.MAP,HR,SpO2and BIS were recoded before administration,at the time of disappearance of eyelash reflex,immediately before and after tracheal intubation,and 1,3 and 5min after tracheal intubation.The time period from sevoflurane inhalation to disappearance of eyelash reflex and to tracheal intubation were recorded.PETCO2 and end-expiratory sevoflurane concentration were recorded.Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy,jaw relaxation,position of vocal cords,degree of coughing and limb movement.Results All patients were successfully intubated at first attempt.The satisfactory intubation conditions were found in 88% in group R and 96% in group S.The difference was not statistically significant（P0.05）.Compared to the time of disappearance of eyelash reflex,the decrease in MAP and BIS were significant both groups,and HR was lower in group R at each other time point,and decreased at 3,5 min post-intubation in group S（P0.05）.MAP,HR remained stable at the time before and after tracheal intubation in group S,and in group R,MAP decreased significantly at post-intubation compared to pre-intubation（P0.01）.The incidence of hypotension and bradycardia in two groups there was no significant difference（P0.05）.BIS value was maintained at 40-60 before and after tracheal intubation.Conclusion 8% Sevoflurane combined with remifentanil and sufentanil provides acceptable tracheal intubating conditions and satisfactory hemodynamic stability,and can be used for tracheal intubation without muscle relaxants.