罗库溴铵用于i-gel喉罩纤维支气管镜检查的临床效果

Effect of rocuuonium on flexible fiberoptic bronchoscopy with i-gel LMA

目的研究罗库溴铵用于i-gel喉罩纤维支气管镜（FOB）检查时的临床效果。方法拟行FOB检查患者58例，随机均分为L组和C组，TCI瑞芬太尼和丙泊酚行麻醉诱导和维持，L组在喉罩插入前1min静注罗库溴铵0．6mg／kg;C组不用肌松药。术中维持BIS40～60。C组FOB进至声门和隆突时分别通过FOB活检孔道注入2％利多卡因3ml。记录手术时间、自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间以及患者和操作者的满意度；丙泊酚、瑞芬太尼用量和血管活性药物使用例数。结果两组手术时间差异无统计学意义。L组自主呼吸恢复时间、呼之睁眼时间、拔管时间、定向力恢复时间明显长于、丙泊酚和瑞芬太尼用量明显少于C组（P〈0．05或P％0．01）。两组喉罩首次插入成功率、FOB首次插入成功率、喉罩密封压、阿托品使用例数差异均无统计学意义。L组麻黄碱使用例数明显低于C组（P〈0．05）。两组患者满意度均为100％；L组操作者满意度为100％，明显高于C组的69％（P〈0．05）。结论应用i-gel喉罩行FOB检查前，静注罗库溴铵0．6mg／kg可使操作者满意度提高，丙泊酚和瑞芬太尼用量减少，但患者恢复时间延长。

] Objective To observe the emergence time, satisfaction of flexible fiberoptic bron- choscopy with i-gel laryngeal mask airway （LMA） with rocuroniurn. Methods Fifty-eight patients scheduled for flexible fiberoptic bronchoscopy were randomly divided into 2 groups： group L and group C（n = 29）. Anesthesia was induced and maintained with TC1 of propofol and remifentanil. The patients in group L were administered rocuronium 0. 6 mg/kg 1 min before LMA insertion. During bronchoscopy BIS was maintained 40-60. In group C glottis and epiglottis were sprayed with 3 ml 2% lidocaine through the biopsy path of fiberoptic bronchoscope. Operation time, recovery time of spontaneous breathing, time of eye opening at request, extubation time, recovery time of orientation, patients satisfaction,operators satisfaction, dose of propofol and remifentanil, were recorded. Results There was no difference in operation time between two groups. The dose of propofol and remifentanil in group C was greater than that in group L. Recovery time of spontaneous breathing, time of eye opening at request, extubation time, recovery time of orientation in group L were longer than that of group C. Pa- tients satisfaction between the two groups was similar, but operators satisfaction in group L was 100%, which higher than 69% in group C. Success rate of LMA placement and flexible fiberoptic bronchoscopy insertion at the first attempt were similar between the two groups. Conclusion Compared with flexible fiberoptic bronchoscopy without rocuronium with i-gel LMA, 0. 6 mg/kg rocuronium make emergence time longer, more satisfaction and more stable hemodynamics.