艾司氯胺酮联合布托啡诺在保留自主呼吸的纤维支气管镜引导气管插管中的应用

Application of esketamine in combination with butorphanol in endotracheal intubation guided by fiberoptic bronchoscopy with spontaneous breathing

目的观察艾司氯胺酮联合布托啡诺在保留自主呼吸的纤维支气管镜(纤支镜)引导气管插管中的应用优势。方法前瞻性选取2021年9月至2022年6月在湖南省人民医院就诊的40例行全麻择期手术疑似困难气道患者, 采用随机数字表法将患者分为对照组和观察组, 分别采用丙泊酚加舒芬太尼、艾司氯胺酮加布托啡诺进行静脉全身麻醉, 同时均辅助环甲膜穿刺和鼻咽、喉部的表面麻醉, 然后在纤支镜引导下经鼻行保留自主呼吸的气管插管。对比两组患者在气管插管前后的心率、平均动脉压、动脉血氧分压和血清皮质醇、去甲肾上腺素和肾上腺素水平变化, 比较插管完成时的体动、呛咳次数。结果对照组插管完成时的心率、平均动脉压较插管前增高, 动脉血氧分压较插管前降低(均P<0.05);插管完成时, 观察组患者的心率、平均动脉压和动脉血氧分压与插管前比较差异均无统计学意义(均P>0.05)。观察组插管完成时的心率、平均动脉压低于对照组, 动脉血氧分压高于对照组(均P<0.05)。气管插管完成时, 观察组患者体动和呛咳次数明显少于对照组(均P<0.01)。气管插管完成时, 观察组患者血清皮质醇、去甲肾上腺素和肾上腺素均明显低于对照组(均P<0.01)。结论艾司氯胺酮联合布托啡诺在保留自主呼吸的困难气道纤支镜引导气管插管的应用中, 较丙泊酚联合舒芬太尼的静脉全麻方式有优势, 能更好地控制气管插管带来的应激反应。

Objective To observe the effects of esketamine combined with butorphanol in endotracheal intubation guided by fiberoptic bronchoscopy with spontaneous breathing.Methods Forty patients suspected of having difficult airways during elective general anesthesia operations in Hunan Provincial People′s Hospital were prospectively selected and divided into control group and observation group by random number table.Propofol plus sufentanil,esketamine plus butorphanol were used for intravenous general anesthesia respectively.At the same time,they were assisted with cricothyroid puncture and surface anesthesia of nasopharynx and larynx,and then trachea intubation with spontaneous breathing was performed through the nose under the guidance of fiberoptic bronchoscope.The changes of heart rate(HR),mean arterial pressure(MAP),arterial partial pressure of oxygen(PaO2),and the levels of serum cortisol,norepinephrine and adrenaline before and after endotracheal intubation were compared between the two groups.The number of body motions and coughing at the completion of endotracheal intubation was compared between the two groups.Results In the control group,the HR and MAP at the completion of intubation were higher than those before intubation,and the PaO2 was lower than those before intubation(all P<0.05);In the observation group,there was no significant difference in HR,MAP and PaO2 at the completion of intubation and before intubation(all P>0.05).The HR and MAP at the end of intubation in the observation group were lower than those in the control group,and the PaO2 was higher than that in the control group(all P<0.05).The number of body motion and coughing in the observation group was significantly less than that in the control group at the completion of endotracheal intubation(all P<0.01).At the end of endotracheal intubation,the serum cortisol,norepinephrine and epinephrine level in the observation group were significantly lower than those in the control group(all P<0.01).Conclusions Esketamine combined with butorphanol has advantages over propofol combined with sufentanil in the application of fiberoptic bronchoscopy guided tracheal intubation in difficult airways that retain spontaneous breathing,and can better control the stress response caused by tracheal intubation.