健忘镇痛慢诱导在梗阻性黄疸患者麻醉诱导期的应用

Application of forgetful analgesia induction in induction period in patients with obstructive jaundice

目的观察健忘镇痛慢诱导气管插管对梗阻性黄疸患者麻醉诱导期血流动力学的影响，探求合理安全的麻醉诱导气管插管方法。方法选择2013年2月一2013年8月在解放军总医院行择期开腹手术的梗阻性黄疸患者60例，其中男36例，女24例，年龄19～65（42±5）岁，体重47—73（54±6）kg，ASAI～Ⅱ级，随机分为健忘镇痛慢诱导气管插管组（A组）和常规快诱导插管组（B组），每组30例。分别记录两组患者诱导前（Tn）、插管前（T1）、插管即刻（T2）及插管后3min（T3）的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）；记录两组患者诱导期是否给予麻黄碱和阿托品及每例患者给予的次数。结果A组诱导前后HR、MAP、SpO2变化差异无统计学意义；与诱导前比较，B组诱导后的HR明显升高（P〈0．05），MAP明显下降（P〈0．05），而SpO2无明显变化。两组患者诱导期均给予麻黄碱和阿托品，但B组给予麻黄碱的例数及次数均明显多于A组（P〈0．05）。结论健忘镇痛慢诱导气管捅管可有效控制应激反应，减轻梗阻性黄疸患者麻醉诱导期血流动力学的波动。

Objective To observe the effect of forgetful analgesia induction and tracheal intubation on the hemodynamic changes in induction period in patients with obstructive jaundice, and explore a safe method for anesthesia induction and tracheal intubation. Methods Sixty patients with obstructive jaundice undergoing elective abdominal operation in General Hospital of PLA from February 2013 to August, 2013 were involved in the present study. Participants included 36 male and 24 female patients, aging 19-65 years （mean 42 ±5 years）, weighing 47-73 kg （mean 54 ± 6 kg）, with ASA I - II. These 60 patients were randomly divided into forgetful analgesia induction-tracheal intubation group （group A, n=30） and rapid induction-tracheal intubation group （group B, n=30）. The heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen saturation （SpOz） at the time point of before induction （To）, before intubation （T1）, at the moment of intubation （T2） and 3 rain after intubation （T3） were determined in both groups. Administration times of ephedrine hydrochloride and atropine was recorded in both groups. Results There was no significant difference in HR, MAP, SpO2 before and after induction in group A. In the patients of group B, the HR increased and MAP decreased after induction compared with those before induction （P〈0.05）, and the change of SpOz was not significant. Ephedrine hydrochloride and atropine were administrated in both groups, and the cases and times of ephedrine hydrochloride administration were more in group B than in group A （P〈0.05）. Conclusion The forgetful analgesia induction-tracheal intubation could effectively control the stress response and reduce the fluctuation in hemodynamics during induction of anesthesia in patients with obstructive jaundice.