成人七氟烷诱导复合不同剂量丙泊酚的插管条件对自主呼吸恢复的影响

Tracheal intubating conditions and apnea time after different dose of propofol during inhalation induction with sevoflurane

目的比较成人七氟烷吸入诱导后给予不同剂量丙泊酚的气管插管条件和自主呼吸恢复时间。方法采用前瞻性随机双盲试验。选择择期全麻手术患者90例,ASAⅠ~Ⅱ级,七氟烷吸入诱导后静脉注射丙泊酚1.0、1.5、2.0mg/kg行气管插管。按丙泊酚剂量随机分为3组,每组30例。观察气管插管条件,自主呼吸恢复时间和术后随访。结果所有患者均顺利完成插管。静脉注射1.0、1.5和2.0mg/kg丙泊酚后分别有50%、76.7%、100%患者插管条件达到可接受,1.5和2.0mg/kg组间差异无统计学意义(P>0.05),且均显著优于1.0mg/kg组。3组自主呼吸恢复时间分别为103.6s、134.1s、196.2s,丙泊酚2.0mg/kg组显著长于另两组,1.5mg/kg组和1.0mg/kg组比较差异无统计学意义(P>0.05)。结论七氟烷诱导时,1.5mg/kg丙泊酚可提供满意气管插管条件且自主呼吸恢复迅速。

Objective Intubation without prior administration of muscle relaxants is a common practice in children and in adults with potential difficult airways. Tracheal intubating conditions and time to resumption of spontaneous breathing were assessed after induction of sevoflurane with different doses of propofol in adult patients. Methods In a prospective, randomized, double-blinded design, 90 ASAI--II patients undergoing operations were randomly divided： propofol 1mg/kg,propofol 1.5mg/kg and propofol 2mg/kg. All patients were given propofol iv after inhalational induc- tion with 8% sevoflurane. The tracheal intubating conditions and time to resumption of spontaneous breathing were eval- uated. The postoperative hoarseness were assessed. Results Tracheal intubation was successful in all patients, lntuba- ring conditions were acceptable in 15 30 （50%）, 23 30（76.7%） and 30 30（100%） in those subjects given propofol 1.0, 1.5 or 2.0 mg/kg. There were no significant differences in clinically acceptable intubating conditions between those given propofol 1.5 and 2.0 mg/kg, but they had greater acceptance than group propofol 1.0 mg/kg. The time to resumption of spontaneous breathing of groups werel03.6s, 134. ls and 196.2s, time to resumption of spontaneous breathing of group prop2.0 was longer than other groups significantly （P〈0.05）. Patients with no hoarseness after operation in group prop2.0 were more than that in group prop1.0. Conclusion After induction with sevoflurane, 1.5-2 mg/kg propofol could produce satisfactory intubating conditions, but propofol 1.5 mg/kg leads to shorter time to resumption of spontane- ous breathing.