无肌松药下TCI瑞芬太尼复合丙泊酚诱导纤支镜经口气管插管的可行性

The feasibility of tracheal intubation with fiberbronchoscope without muscle relaxant after induction of anesthesia with propofol-remifentanil by TCI

目的探讨TCI瑞芬太尼复合丙泊酚在无肌松药下诱导纤维支气管镜(纤支镜)经口气管插管的可行性。方法择期行气管插管全身麻醉下的手术患者80例,ASAⅠ级。随机分为4组(n=20),瑞芬太尼效应室靶浓度分别为2.5(Ⅰ组)、3.0(Ⅱ组)、3.5(Ⅲ组)和4.0μg/L(IV组)。丙泊酚效应室靶浓度固定为3μg/mL。TCI瑞芬太尼5min后再TCI丙泊酚,10min后行纤支镜气管插管。记录麻醉诱导前基础值,TCI丙泊酚结束时、气管导管置入气管时各时点HR、MAP和脑电双频谱指数(BIS)值,同时进行气管插管条件评分。结果气管插管满意率Ⅰ、Ⅱ、Ⅲ和Ⅳ组分别为45%、55%、75%和80%,Ⅲ和Ⅳ组分别与Ⅰ组相比差异均有显著性(P<0.05)。结论不使用肌松剂的情况下,TCI瑞芬太尼3.5或4.0μg/L复合丙泊酚可提供较好的纤支镜经口气管插管条件,但对血流动力学有一定的负面影响。

[Objective] To investigate the feasibility of tracheal intubation with fiberbronchoscope without muscle relaxant after induction of anesthesia with propofol-remifentanil by TCI.[Methods] Eighty ASA Ⅰpatients,scheduled for elective operation under general anesthesia were randomly divided into four groups（n=20 each） according to the target effect site concentration of remifentanil：2.5 μg/L（GroupⅠ）,3.0 μg/L（GroupⅡ）,3.5 μg/L（Group Ⅲ） and 4.0 μg/L（Group IV）.The target effect site concentration of propofol was 3μg/mL.Five minutes after remifentanil by TCI,propofol were given by TCI.Tracheal intubation with fiberbronchoscope was executed in 10 minutes.The baseline value of MAP,HR and BIS were recorded before intubation,end of TCI propofol and endotracheal tube into tracheal.The grade of intracheal intubation was evaluated.[Results] Satisfactory rate of intracheal intubation was 45%,55%,75% and 80% in GroupⅠ,GroupⅡ,Group Ⅲ and Group IV respectively.Satisfactory rate of intracheal intubation in Group Ⅲ or Group IV was higher than Group Ⅰ（P 0.05）.[Conclusion] Without muscle relaxant,3.5μg/L and 4.0μg/L remifentanil combined with 3μg/mL propofol by TCI might provide satisfactory tracheal intubation conditions with fiberbronchoscope,meanwhile it would bring about instable effect on hemodynamics.