不同剂量丙泊酚复合瑞芬太尼在经鼻纤维支气管镜插管中的应用

The application of different doses Propofol compounded Remifentanil in fiberoptic bronchoscope nasal intubation

目的观察经鼻纤支镜气管插管患者不同剂量丙泊酚复合瑞芬太尼的麻醉效果,探讨经鼻纤支镜气管插管术中丙泊酚麻醉的适宜剂量。方法将60例择期需经鼻纤支镜气管插管全麻下行口腔颌面外科手术的病人随机分为三组(n=20),按丙泊酚静脉输注速率,分别为4 mg/(kg.h)组(P1组)、6 mg/(kg.h)组(P2组)和8 mg/(kg.h)组(P3组)。三组均先给静脉注射瑞芬太尼1μg/kg(给药时间不低于60 s),然后按6μg/(kg.h)静脉泵注瑞芬太尼。静脉注射丙泊酚2 mg/kg后分别以4、6、8 mg/(kg.h)静脉输注丙泊酚。丙泊酚静脉输注5 min后经鼻纤支镜气管插管。记录三组病人麻醉诱导时SBP、DBP、MAP、HR最低值及气管插管时最高值、气管插管所用时间;观察三组病人麻醉诱导过程中呼吸暂停的发生情况及气管插管时患者的不良反应;计算气管插管一次性成功率。结果 P1、P2组一次性经鼻纤支镜气管插管成功率低,气管插管完成时间长;而P3组麻醉较深,血流动力学平稳,插管条件好,气管插管一次性成功率高,虽然患者呼吸暂停时间较长,但通过有效辅助通气均可缓解,对患者生命安全无威胁。结论在经鼻纤支镜气管插管术中以8 mg/(kg.h)静脉输注丙泊酚复合瑞芬太尼麻醉比较适宜。

Objective To observe the anesthetic effects of Propofol compounded Remifentanil at different doses in patients with the nasal fiberoptic intubation and analyze the optimize doses for clinical usage.Methods 60 patients who were required nasal fiberoptic intubation to perform the maxilla facial surgery were randomly divided into three groups according to the rate of intravenous infusion of Propofol： 4mg/（kg·h）group（P1 group）,6mg/（kg·h）group（P2group） and 8mg/（kg·h）group（P3 group）.All these 3 groups were initially administrated Remifentanil by intravenous injection at 1μg/kg with no less than 60 second of delivery,and then with intravenous infusion of the same drug at 6μg/（kg·h）.After intravenous injection of Propofol at 2mg/kg,to intravenous inject the Propofol at different doses of 4,6,8 mg/（kg·h） respectively.Intubation was performed at 5min after intravenous infusion of Propofol.After 4 minutes of infusion later,the nasal fiberoptic intubation was performed.To record SBP,DBP,MAP,the lowest and highest value of HR and time for intubation.The incidence of apnea and side-effect were observed and one time successful rate was calculated.Results One time successful rate of tracheal intubation in P1 and P2 groups was lower,and it took a long time to finish tracheal intubation,but P3 group showed the deeper anesthesia,more stable hemodynamics,good conditions for intubation and higher one time intubation successful rate.Although the apnea time was long,but can be alleviated by effective assisted ventilation.Conclusion Intravenous infusion of Propofol and Remifenitanil at 8mg/（kg·h） is the appropriate doses for clinical usage.