丙泊酚瑞芬太尼合剂用于经鼻清醒气管插管的临床观察

Clinical observation of propofol-remifentanil for awake nasotracheal intubation

目的观察丙泊酚瑞芬太尼合剂(丙瑞合剂)应用于清醒经鼻盲探插管患者的临床效果。方法选择行口腔颌面手术需清醒经鼻插管患者34例,随机分为丙瑞合剂组(P组)和对照组(C组),各17例。P组静脉持续泵注丙瑞合剂0.2 mL/(kg.h)[丙泊酚1.9 mg/(kg.h)+瑞芬太尼5μg/(kg.h)],C组:静脉同时分别泵注丙泊酚1.9 mg/(kg.h)和瑞芬太尼注射液5μg/(kg.h),3 min后行经鼻气管插管。分别于麻醉前(T0)、导管进入咽腔即刻(T1)和导管插入气管即刻(T2)记录患者心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)及脑电双频指数(BIS),观察插管过程中镇静情况,有无躁动、恶心、呛咳和呼吸抑制,术后随访插管知晓情况。结果与T0时间点比较,C组在T1和T2时刻HR与MAP升高,在T1时刻BIS降低(P<0.05)。P组在T1和T2时刻SpO2与BIS降低(P<0.05)。与C组相比,P组T1和T2时刻MAP、HR及SpO2下降,T2时刻P组BIS值低于C组(P<0.05)。与C组比较,P组镇静不足/过度、躁动及插管知晓的发生率减少,清醒镇静的效果也优于C组(P<0.05)。结论与丙泊酚复合瑞芬太尼分别静脉泵注比较,等剂量丙瑞合剂用于清醒经鼻盲探插管能更有效维持血液动力学和麻醉深度的稳定,达到良好的清醒镇静效果并减少插管并发症的发生。

Objective To investigate the effects of propofol-remifentanil on nasotracheal intubation of con- scious patients. Methods 34 oral and maxillofacial surgical patients with nasotracheal intubation were randomized into propofol-remifentanil group（ group P）and control group（ group C）with 17 cases in each group. Group P received con- tinous infusion of propofol-remifentanil with the rate of 0. 2 mL/（ kg- h ） E propofol 1.9 mg/（ kg. h ） and remifentanil 5 μg/（ kg. h） ] , while group C received continous injection of propofol 1.9 rag/（kg-h） combined with remifentanil 5 p,g/（kg.h）. Nasotracheal intubution was performed at 3 rain after propofol and remifentanil continous injection. HR, MAP, SpO2 and BIS were respectively monitored and recorded before anesthesia（ To , baseline）, when tracheal tube was inserted into nasal（ T2 ）, and when the tube was threaded onto trachea（ T3 ）. Cases of conscious sedation and responses, such as restlessness, nausea, coughing and respiratory depression were observed in intubation process. The follow-up visit of awareness was preformed after intubation operation. Results HR and MAP significantly increased at T1 and T2 ,and BIS significantly decreased at T1 compared with the baseline values before anesthesia at TO in group C（ P 〈 0. 05）. SpO2 and BIS decreased at T1 and T2 compared with the baseline values of P group（P 〈0. 05）. MAP,HR and SpO2 in group P at T1 and T2 and BIS at T2 were obviously lower than those in control group（ P 〈 0. 05 ）. The incidence of restlessness, coughing and aware of intubation were significantly lower in group P than that of group C, and the effect conscious sedation was superior to group C （ P 〈 0. 05 ）. Conclusion Compared with continous injection of propofol combined with remifentanil, using isodose propofol-remifentanil during awake nasotracheal intubation is more effective in maintaining the stability of haemodynation and anesthsia depth, which achieves well conscious sedation and reduces the incident of intubation complication.