无肌松剂条件下气管插管全身麻醉在上肢骨折内固定术中的应用研究

Application study of endotracheal intubation general anesthesia without muscle relaxant in internal fixation of upper limb fracture

目的探讨无肌松剂条件下表面复合静脉气管插管全身麻醉（全麻）应用于上肢骨折内固定术的可行性。方法选择80例需行上肢骨折内固定术的患者,美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级且无困难插管表现,随机分为无肌松剂组（A组）和对照组（B组）,每组40例,采用舒芬太尼-丙泊酚诱导,瑞芬太尼-丙泊酚维持气管插管全麻,其中A组诱导时予复合咽喉及气管内表面麻醉,B组诱导及维持中按常用剂量使用阿曲库铵。对两组的插管条件,诱导及插管致平均动脉压（MAP）和心率（HR）波动情况进行比较,并比较两组患者术中肢体活动和呛咳反射及拔管后并发症发生情况,以及两组患者自主呼吸恢复时间、拔管时间和出麻醉后恢复室（PACU）时间。结果两组患者插管条件满意率比较,差异无统计学意义（P〉0.05）,但B组优秀率显著高于A组（P〈0.01）;诱导及插管致两组患者MAP、HR均有明显波动,但B组较A组稳定;术中两组患者均无呛咳反射,A组仅有3例有轻度肢体活动;A组患者中无喉痉挛者,咽喉不适或疼痛者明显少于B组（P〈0.05）;A组患者自主呼吸恢复时间、拔管时间和出PACU时间均明显短于B组（P〈0.05）。结论无肌松剂条件下表面复合静脉气管插管全麻可安全应用于ASAⅠ~Ⅱ级上肢骨折内固定术的患者。

Objective To explore the feasibility of tracheal intubation under superficial anesthesia combined with intra- venous general anesthesia without muscle relaxant applied in the internal fixation of upper limb fracture. Methods 80 patients needing internal fixation of upper limb fracture, ASA I - H without difficult airways,were selected and randomly divided into the no muscle relaxant group （A） and the control group （B）, 40 cases in each group. Sufentanil-propofol was adopted for induction and remifentanil-propofol for maintenance general anesthesia by tracheal intubation. The group A was induced by composite throat and intratracheal superfical anesthesia, and the group B was induced and maintenance by commonly used dose of atracurium. The intubation conditions ,mean arterial pressure（MAP） and heart rate（HR） fluctuations caused by induction and intubation were com- pared between the two groups. Also the intraoperative limb movements,choking actions, complications after extubation, recovery times needing to spontaneous breathing, extubation time, releasing time from PACU were compared between the two groups. Re- stilts The satisfactory rates of the intubating conditions in the two groups had no statistically significant difference （P〉0.05）, but the excellent rate in the group B was significantly higher than that in the group A（P〈0.01 ）. MAP and HR had significant fluc- tuations caused by induction and intubation in the two groups, but the group B was more stable than group A. The two groups had no cough actions during operafion,the group A had 3 cases of mild limb movement;the group A had no laryngeal spasm,and throat discomfort or pain in the group A were obviously less than those in the group B. The spontaneous breathing recovery time, extuhation time and leaving PACU time in the group A were significantly shorter than those in the group B （P〈0.05）. Conclusion Surface anesthesia combined intravenous general anesthesia with tracheal intubation without muscle relaxant can be safely ap- plied to the ASA I - U patients undergoing upper limb fracture internal fixation.