清醒气管插管摆放俯卧位后诱导全身麻醉的研究

Study of the induction of general anesthesia in the prone position with awake endotracheal intubations

目的探讨俯卧位全身麻醉手术的患者，在其清醒气管插管白行摆放俯卧位后再行伞身麻醉诱导的临床可行性。方法选择30例需行全身麻醉下俯卧位手术的患者，分别采用纤维是气管镜引导清醒气管插管后，患者根据自身的舒适度配合医务人员摆放俯卧位。记录患者基础状态（TO）、插管过程（T1）和摆放体位（T2）时的血流动力学参数：收缩压（SBP）、舒张压（DBP）和心牢（HR），并计算心率收缩压乘积（RPP）及参数的变化范同。结果30例患者中28例均能顺利配合完成整个过程，成功28例（93．3％）。在T1、T2时相SBP、DBP、HR和RPP数据比较rm均有增加，但仅有T1DBP[（92．2±11．6）mmHg（1mmHg=0．133kPa）]增高较T0[（78．1±12．7）mmHg]雄哗有统计学意义（P〈0．05），且RPP最大值均小于22000，T1、T2两个时相SBP、DBP、HR最大值较T0时相变化率均小于30％。结论全身麻醉下俯卧位手术的患者，在纤维支气管镜引导下清醒气管插管后患者自行摆放俯卧位是可行的。

Objective To discuss the feasibility of patients accepting general anesthesia induction after lying in the prone position by themselves with awake endotraeheal intubations. Methods 30 patients who needed prone position surgeries were selected. After an awake fiberoptic endotracheal intubation, the patients in the waking state lied in the prone position according to their own comfort with the guide of medical staff. The statistics of systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and heart rate （HR） were recorded respectively in the basal state （T0）, in the time of intubations （T1）, in the time of the body turning （T2）. The rate pressure product （RPP） and the changed of the parameter were also calculated. Results 30 of 32 patients completed the whole process guided by medical staff, 30 were success- ful （93.8%）. There was a slight increase in statistics of SBP, DBP, HR and RPP in phase T1, T2 compared with that in phase TO. But only in the DBP increase which T1 [ （92. 2 ± 11.6） mmHg （ 1 mmHg = 0. 133 kPa）] compared with that in phase TO [ （78. 1 ± 12. 7 ） mmHg ] was statistical significance （P 〈 0. 05）. And the maximum of RPP all less than 22 000. The changed in statistics of SBP, DBP, HR and RPP in phase T1, T2 compared with that in phase TO were also less than 30%. Conclusion It is feasible that patients waiting for operations under general anesthesia lie in the prone position by themselves after awake flexible fiberoptic intubation.