无肌肉松弛药下内镜经口气管插管的可行性研究

Feasibility of endoscope guided orotracheal intubation without muscle relaxant

目的评估无肌肉松弛药（肌松药）条件下瑞芬太尼复合丙泊酚诱导内镜经口气管插管的可行性。方法选择拟行气管插管全身麻醉的手术患者40例，ASA分级Ⅰ、Ⅱ级。采用随机数字表法将患者分为2组（每组20例）：无肌松药插管组（N组）与罗库溴铵插管组（R组）。N组静脉注射咪达唑仑、瑞芬太尼与丙泊酚行麻醉诱导，R组静脉注射咪达唑仑、瑞芬太尼、丙泊酚及罗库溴铵行麻醉诱导，诱导后两组静脉泵注丙泊酚3 mg·kg-1·h-1、瑞芬太尼0.3 μg·kg-1·min-1维持麻醉。患者意识消失且BIS〈60，再行过度通气2 min，置入气管导管，行机械通气。记录两组成功插管例数、插管次数、每次插管时间、总的插管时间、插管过程中的副作用、气管插管条件评估及术后并发症。结果两组患者成功插管例数、插管次数、总的插管时间、插管过程中的副作用及术后并发症比较，差异无统计学意义（P〉0.05）；N组插管条件综合评价满意率为85%，R组为95%，差异无统计学意义（P〉0.05）。结论内镜无肌松药条件下插管安全、可靠，成功率高、副作用少，具有临床可行性。

ObjectiveTo evaluate the feasibility of endoscope-guided orotracheal intubation without muscle relaxant after induction of anesthesia with remifentanil and propofol.MethodsForty patients with ASA class Ⅰ or Ⅱ scheduled for elective operation under general anesthesia were randomly divided into 2 groups （n=20）： subjective to endotracheal intubation without muscle relaxant（group N） or endotracheal intubation with rocuronium, a muscle relaxant （group R）. Anesthesia in both groups was induced with midazolam, remifentanil, and propofol, and maintained with propofol（3 mg·kg-1·h-1） and remifentanil（0.3 μg·kg-1·min-1） after induction. When patients became unconscious with BIS〈60, endotracheal intubation was performed after 2 min mechanical hyperventilation. The number of cases of successful intubation, number of attempts, duration of each attempt, total intubation time, and incidence of adverse reactions during the procedure were recorded.ResultsThere was no difference between the two groups in the number of cases of successful intubation, number of attempts, total intubation time, adverse reactions during the procedure and the incidence of postoperative complications（P〉0.05）. The comprehensive satisfaction rate for the endotracheal intubation was not different in the two groups with 85% in group N and 95% in group R（P〉0.05）.ConclusionsEndoscope-guided orotracheal intubation is safe and effective in patients without a muscle relaxant.