顺式阿曲库胺在插管型喉罩辅助纤支镜诊疗中的应用

Application of cisatracurium in clinical use of intubating laryngeal mask airway for painless bronchoscopy

目的:探讨顺式阿曲库胺在插管型喉罩辅助纤支镜诊疗中的应用效果。方法:选取2013年10月至2015年2月在我院拟行纤支镜检查者60例,随机分为观察组(n=30)和对照组(n=30),2组均给予插管型喉罩辅助通气,观察组在对照组全麻的基础上加用低剂量肌松药物顺式阿曲库胺,记录麻醉前(T1)、置入喉罩时(T2)、纤支镜过声门时(T3)、检查完毕时(T4)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SPO2)、呼末二氧化碳分压(end-tidal carbon dioxide partial pressure,ETCO2)、脑电双频指数(bispectral index,BIS)等,并记录2组患者的镜检时间、自主呼吸恢复时间、呼之睁眼时间、喉罩拔除时间及麻醉后恢复室停留时间。结果:观察组T3时间点MAP、HR明显低于对照组,差异有统计学意义(P=0.000,P=0.000);观察组T3时间点SPO2明显高于对照组,差异有统计学意义(P=0.000);观察组T2、T3、T4时间点ETCO2低于对照组,差异有统计学意义(P=0.001,P=0.000,P=0.000);观察组和对照组BIS在各个时间点比较差异无统计学意义(P=0.235,P=0.614,P=0.455,P=0.546);观察组芬太尼和丙泊酚用量低于对照组,差异比较有统计学意义(P=0.000,P=0.000);2组的麻醉效果无统计学差异(P=0.378)。2组患者呼之睁眼时间、喉罩拔出时间及PACU停留时间组间比较,差异无统计学意义(P=0.057,P=0.071,P=0.094);观察组自主呼吸恢复时间长于对照组,差异有统计学意义(P=0.030)。结论:低剂量顺式阿曲库胺在插管型喉罩辅助纤支镜诊疗中血流动力学更平稳,同时能减少镇静药和镇痛药的用量,也并没增加在PACU停留时间。

Objective：To investigate the effect of cisatracurium in clinical use of intubating laryngeal mask airway for painless bronchoscopic diagnosis and therapy. Methods：Sixty patients were selected from October 2013 to February 2015 in our hospital who received painless bronchoscopy,and were randomly divided into observation group（n=30）and control group（n=30）. The intubating laryngeal mask airway was used in both groups for mechanical ventilation. The cisatracurium was used for the patients in observation group. Vital signs include mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（SPO2）,end-tidal carbon dioxide partial pressure（ETCO2）and bispectral index（BIS）were recorded at four points,anesthesia induction（T1）,laryngeal mask insertion（T2）,fiberoptic bronchoscope passing through the glottis（T3）,end of diagnosis（T4）. The spontaneous breathing recovery time,the awakened eye opening time,extubation time and the time of postanesthesia staying in care unit in both groups were recorded and evaluated. Results：The MAP and HR at T3 point were significantly lower in observation group than in control group（P=0.000）. The SPO2 at T3 point were significantly higher in observation group than in control group（P=0.000）. The ETCO2 at T2,T3,T4 at points were significantly lower in observation group than in control group（P=0.001,P=0.000,P=0.000）. There was no significant difference of BIS in both groups（P=0.235,P=0.614,P=0.455,P=0.546）. The doses of fentanyl and propofol were obviously reduced in observation group than in control group（P=0.000,P=0.000）. There was no significant statistically differences in the outcomes of general anesthesia（P =0.378）. There was no significant differences in the awakened eye opening time,extubation time and the time of postanesthesia staying in care unit in both groups（P=0.057,P=0.071,P=0.094）. The spontaneous breathing recovery time was significantly longer in observation group than in control group（P=0.030）. Conclusion：Low cisatracurium,as a muscle relaxant,is a helpful supplementary drug in clinical use of intubating laryngeal mask airway for painless bronchoscopy with more stable hemodynamics,which also can reduce the consumption of sedative or analgesic drugs and show no increase on the time in PACU.