氯化琥珀胆碱对快速诱导气管插管后中心静脉血氧饱和度的影响

Effect of Succinylcholine Chloride on Central Venous Oxygen Saturation after Rapid Induction Endotracheal Intubation

【目的】比较去极化肌松药和非去极化肌松药快速诱导气管插管对患者上腔静脉血氧饱和度的影响。【方法】将50例下腹部非腔镜外科手术和非创伤性骨折的单侧上、下肢择期手术患者按随机数表法分为观察组和对照组各25例,分别使用氯化琥珀胆碱(1.2 mg/kg)和顺苯磺酸阿曲库铵(0.25 mg/kg)快速诱导气管插管。在入宝时(T_(0))、气管插管后1 min(T_(1))、3 min(T_(2))、10 min(T_(3))和手术开始后10 min(T_(4))采集上腔静脉血进行血气分析,比较各时间段两组患者的上腔静脉血氧分压(PevO_(2))、上腔静脉血氧饱和度(ScvO_(2))以及血糖(GLUev).乳酸(LACev)的改变。【结果】T_(0)时两组患者PevO_(2)、SevO_(2).GLUev、LACev组间比较差异无显著性(P>0.05);T_(1)时,对照组患者PevO_(2)、SevO_(2)高于观察组,差异有统计学意义(P<0.05)。对照组患者气管插管时出现轻微呛咳、肢体运动、气管入口滞留时间延长等不良反应发生率为40%,明显高于观察组的8%,其差异有统计学意义(χ^(2)=8.47.P<0.05)。【结论】与顺苯磺酸阿曲库铵比较。小剂量琥珀胆碱诱导下快速气管插管时气管插管条件更佳,有效抑制气管插管引起的呛咳反射,气管插管后循环、PevO_(2)、SevO_(2)指标更稳定,有利于组织氧供需平衡。

【Objective】To compare the effects of depolarized muscle relaxants and non depolarized muscle relaxants on superior vena cava oxygen saturation.【Methods】A total of 50 patients with lower abdominal non endoscopic surgery and unilateral upper and lower limb elective surgery for non traumatic fractures were randomly divided into observation group and control group,with 25 cases in each group.Endotracheal intubation was rapidly induced by succinylcholine chloride(1.2mg/kg)and atracurium CIS benzenevSulfonate(0.25 mg/kg),respectively.The superior vena cava blood was collected at the time of entry(T_(0)),1 min(T_(1)),3 min(T_(2)),10 min(T_(3))after endotracheal intubation and 10 min(T_(4))after operation for blood gas analysis.The changes of superior vena cava oxygen partial pressure(PcvO_(2)),superior vena cava oxygen saturation(ScvO_(2)),blood glucose(GLUcv)and lactic acid(LACcv)were compared between the two groups.【Results】There was no significant difference in PcvO_(2),ScvO_(2),GLUcv,LACcv between the two groups at To(P>0.05);At T_(1),PcvO_(2) and ScvO_(2) in the control group were higher than those in the observation group(P<0.05).The incidence of mild cough,limb movement and prolonged retention time at the tracheal inlet in the control group was 40%,which was significantly higher than 8%in the observation group(χ^(2)=8.47,P<0.05).【Conclusion】Compared with atracurium CIS benzenesulfonate,low-dose succinylcholine induced rapid endotracheal intubation has better endotracheal intubation conditions,effectively inhibits the choking reflex caused by endotracheal intubation,and the indexes of circulation,PcvO_(2) and ScvO_(2) after endotracheal intubation are more stable,which is conducive to the balance of tissue oxygen supply and demand.