无肌松药下靶控输注瑞芬太尼在困难气道光棒引导气管插管中的应用

Application of target-controlled infusion of remifentanil without muscle relaxants in difficult airway light rod-guided tracheal intubation

目的:探讨无肌松药下靶控输注瑞芬太尼在困难气道光棒引导气管插管中的应用.方法:选择2017年2月至2019年10月在成都医学院附一名山分院行气管插管术的困难气道患者82例进行研究.患者随机分为2组,各41例.对照组采用瑞芬太尼单次注射的给药方法,观察组则采用靶控输注的方式麻醉.比较2组患者插管成功率、应激反应指标、生命体征、麻醉苏醒时间及插管反应发生情况.结果:对照组共出现39例(95.12%)插管成功,观察组40例(97.56%)插管成功,无显著差异(P>0.05).麻醉前两组血糖、皮质醇及去甲肾上腺素水平差异无统计学意义(P>0.05),插管后两组患者血糖、皮质醇及去甲肾上腺素水平均明显升高,但对照组高于观察组(P<0.05).麻醉前与插管后两组血氧饱和度比较差异均无统计学意义(P>0.05),麻醉前两组患者舒张压、收缩压及心率差异无统计学意义(P>0.05),插管后观察组舒张压、收缩压及心率均低于对照组(P<0.05).观察组恢复自主呼吸时间、呼之睁眼时间、完成指令时间及拔除气管导管时间均较对照组更短(P<0.05).对照组共出现8例(20.51%)插管反应,呛咳2例,躁动5例,套囊充气反应1例;观察组出现2例(5.00%)插管反应,呛咳1例,躁动1例.两组差异有统计学意义(P<0.05).结论:无肌松药下靶控输注瑞芬太尼与单次输注均可提高困难气道光棒引导气管插管成功率,但靶控输注应激反应更小,对血压及心率的影响更小,还可降低插管反应的发生率.

Objective:To explore the application of target-controlled infusion of remifentanil without muscle relaxants in difficult airway light rod-guided tracheal intubation.Methods:82 patients with difficult airway undergoing tracheal intubation in the Mingshan Branch of the First Affiliated Hospital of Chengdu Medical College from February 2017 to October 2019 were selected for the study.The patients were divided into 2 groups by random number table method,41 cases in each group.The control group was given a single injection of remifentanil,and the observation group was anesthetized by target-controlled infusion.The intubation success rate,stress response index,vital signs,anesthesia recovery time and intubation reaction occurrence were compared between the two groups.Results:A total of 39 cases(95.12%)in the control group and 40 cases(97.56%)in the observation group were successfully intubated,with no significant difference between the two groups observed(P>0.05).There was also no significant difference in the levels of blood glucose,cortisol and norepinephrine between the two groups before anesthesia(P>0.05).After intubation,the levels of blood glucose,cortisol and norepinephrine in the two groups were significantly higher than those in the observation group(P<0.05).There was no significant difference in blood oxygen saturation between the two groups before and after intubation(P>0.05).There was no significant difference in diastolic blood pressure,systolic blood pressure and heart rate between the two groups before anesthesia(P>0.05).The diastolic blood pressure,systolic blood pressure and heart rate of the observation group were lower than those of the control group(P<0.05).The time for the observation group to recover spontaneous breathing,to open the eyes,to complete the instruction and to remove the intubation were shorter than those in the control group(P<0.05).In the control group,8 cases(20.51%)had intubation reaction,2 cases of choking,5 cases of restlessness,and 1 case of cuff-inflation reaction;in the observation group,2 cases(5.00%)had intubation reactions,1 case of coughing,and 1 case of restlessness.The difference between the two groups was statistically significant(P<0.05).Conclusion:Target controlled infusion of remifentanil without muscle relaxant and single infusion can improve the success rate of tracheal intubation guided by light rod in difficult airway,but target controlled infusion has less stress response,less influence on blood pressure and heart rate,and can reduce the incidence of intubation reaction.