改良快速顺序诱导法在腹腔镜手术麻醉中的应用

Modified rapid sequence induction in anesthesia for laparoscopic surgery.

目的探讨改良快速顺序诱导法在腹腔镜手术麻醉中的安全性和有效性。方法择期全麻下腹腔镜手术患者120例,ASAI-II级,年龄20~50岁,随机分为对照组(C组)和观察组(S组),每组60例。C组采用常规麻醉诱导方法,S组采用改良的快速顺序诱导法,诱导过程中不实施人工辅助通气。记录麻醉诱导开始至出现呼吸抑制的时间、出现呼吸抑制至气管插管成功时间、插管成功即刻P ET CO2和SpO2,并对手术区视野评级。结果 C组和S组麻醉诱导开始至出现呼吸抑制的时间分别为(74.2±12.8)s和(72.8±14.7)s,出现呼吸抑制至气管插管成功时间分别为(128.4±15.7)s和(133.1±13.9)s,插管成功即刻SpO2分别为(98.3±1.2)%和(97.7±2.0)%,P均>0.05。插管成功即刻S组P ET CO2明显高于C组,分别为(48.4±3.8)cmH2O和(37.2±3.7)cmH2O,P<0.01。手术区视野评级为"优"、"良"和"差"的比例中,S组分别为43例(71.7%)、14(23.3%)和3(5.0%),C组分别为25例(41.7%)、27(45.0%)和8(13.3%),P均<0.01。结论腹腔镜手术麻醉时,正确实施改良快速顺序诱导能避免低氧血症,提供良好的手术视野,可安全应用腹腔镜手术患者的麻醉诱导。

Objective To investigate the safety and efficacy of modified rapid sequence induction in anesthesia for laparo- scopic surgery. Methods 120 patients （ASAI-II, aged from 20 to 50 years old） were selected to undergo laparoscopic surgery under general anesthesia. They were randomly divided into the control group （C group） and the observation group （S group）, 60 patients in each group. Conventional induction of anesthesia was used in group C while modified rapid sequence induction was used in S group, and assisted ventilation was not implemented in the induction process. The time from the start of the induction of anesthesia to the presence of respiratory depression, the time from the presence of respiratory depression to the success of tracheal intuba- tion and immediate P^TCO2 and SpO2 after the success of intubation were recorded; and the grade of the exposure in the operation field were recorded too. Results In C group and S group, the time from the start of the induction of anesthesia to the presence of re- spiratory depression were （74.2 ± 12. 8） s and （72. 8 ± 14. 7） s, respectively, and the time from the presence of respiratory depres- sion to the success of tracheal intubation were （128.4 ± 15.7 ）s and （133.1 ± 13.9）s, respectively. Immediate SpO2 after the suc- cess of intubation were （98. 3 ± 1.2 ） % and （97. 7 ± 2. 0 ） %, respectively. The three observed indicators showed no statistical difference between the two groups （P 〉 0. 05）. Immediate PETCO2 after the success of intubation of S group was significantly higher than that of C group. They were （48.4 ± 3.8 ）cm H 2 0 and （37. 2 ± 3.7 ）cm H2 O, respectively, showing significant differences be- tween two groups （P 〈0.01 ）. The grade of the exposure in the operation field, in S group, 43 （71.7%）, 14 （23. 3.% ） and 3 pa- tients （5.0%） and in C group, 25 （41.7%）, 27 （45.0%） and 8 patients （13.3%）, were rated ＂excellent＂, ＂good＂ and ＂poor＂, respectively. Ratings were statistically different between two groups （ P 〈 0.01 ）. Conclusion In anesthesia of laparoscopic surgery, the correct implementation of the modified rapid sequence induction could avoid hypoxemia and provide good operation field. It could be safely applied in the induction of anesthesia of patients undergoing laparoscopic surgery.