舒芬太尼复合瑞芬太尼在困难气道清醒气管插管中的效果

Efficacy of Sufentanil Combined with Remifentanil in Awake Intubation with Anticipated Difficult Air Ways

目的:探讨舒芬太尼与瑞芬太尼复合用药在困难气道清醒插管中应用的安全性和有效性。方法:2009年10月～2010年4月在我院选择困难气道需清醒气管插管患者66例,66例患者随机分为Ⅰ、Ⅱ、Ⅲ3组,在充分表面麻醉后,Ⅰ组(环甲膜穿刺组)环甲膜穿刺并注入2%利多卡因2 ml,而后行插管操作;Ⅱ组(瑞芬太尼组)瑞芬太尼0.75μg/kg的一次剂量后以每分钟0.075μg/kg持续静脉注射;Ⅲ组(舒瑞芬太尼复合组)给予舒芬太尼0.75μg/kg的一次剂量后以瑞芬太尼0.075μg/kg持续静脉注射。记录3组患者在诱导前、插管过程中以及导管进入气管后的心率、血压、血氧饱和度。结果:3组均能够完成气管插管。Ⅲ组的血流动力学变化明显小于前两组,3组差异有统计学意义(P<0.05)。结论:在表面麻醉基础上,舒芬太尼复合瑞芬太尼能更好的完成困难气道的清醒插管,血流动力学变化更小,更为安全,更为舒适。

Objective：To investigate the safety and effectivity of sufentanil combinde with remifentail in awake intubation with difficult air ways.Methods：Atotal of 66 patients with known difficult airways who underwent awake tracheal intubation were recruited.Patients were randomly divided into three groups（namely Group Ⅰ,Group Ⅱ and Group Ⅲ）.After sufficient superficial anesthesia,group Ⅰ（n=22）received thyrocricoid puncture,and then injected 2ml（2%） lidocaine before intubating;Group Ⅱ（n=22） received remifentanil 0.75 μg/kg in bolus,followed by acontinuous infusion of 0.075 μg·kg-1·min-1,and group Ⅲ（n=22） receivde sufentanil 0.75μg/kg in bonus,followed by continous infusion of remifentanil 0.075 μg·kg-1·min-1.The outcomes included HR,BP and SpO2 before,during and after intubation.Results：All the patients wer able to complete awake intubation.Haemodynamic changes in group Ⅲ were significantly fewer than in group Ⅰ and group Ⅱ.We found significant differences among the three groups.Conclusion：After superficial anaesthesia,awake intubation is better achinved by continous injection of sufentanil combined with remifentanil,which fewer haemodynamic changes,and more comfort and safety.