喉颈联合手术经气管切开插管麻醉诱导药物的选择与应用  

Evaluation of anesthetics during induction in the intubation in tracheotomy for laryngeal and neck operation

作　　者：孟照杰[1] 王方[1] 王业贵[1] 杜娟[1] 

机构地区：[1]天津市第四中心医院麻醉科,天津300140

出　　处：《山东大学基础医学院学报》2005年第3期183-184,共2页Journal of Preclinical Medicine College of Shandong Medical University

摘　　要：目的:比较3种静脉麻醉药在喉颈联合手术经气管切开插管麻醉诱导中的效果。方法:随机将10 8例SASⅠ～Ⅱ级择期全喉切除伴单侧或双侧颈淋巴清扫患者分为3组,A组:羟丁酸钠诱导剂量为6 5 .0 0±19 .0 0mg/kg ,B组:依托咪酯诱导剂量为0 .2 8±0 .12mg/kg ,C组异丙酚诱导剂量为2 .1±0 .2 8mg/kg。3组患者均在局麻气管切开手术开始后,予以咪唑安定0 .1～0 .2mg/kg ,芬氟合剂2～3ml ,并以2 %利多卡因经气管注入行表面麻醉,按3种药物不同的起效时间注入静脉,观察3组患者麻醉诱导前后,气管插管后的HR ,MAP ,RR和SpO2 的变化。结果:A组呼吸变慢18例,SpO2 比诱导前降低明显,MAP升高,差异有显著性(P <0 .0 1)。B组RR、HR、MAP与诱导前差异无显著性。C组入睡时间起效迅速,用药后MAP下降明显,与诱导前差异有高度显著性(P <0 .0 1)。SpO2 有下降趋势,但均在正常范围。结论:依托米酯,异丙酚均可作为喉颈联合手术经气管切开插管麻醉诱导剂。Objective: To compare the effects of three anesthetics during induction in the intubation by tracheotomy for laryngeal and neck operation.Methods: One hundred and eight patients (ASAⅠ-Ⅱ)undergoing laryngectomy were assigned randomly into three groups,induced anesthesia by sodium oxybate 65.0±19.0mg/kg(groupA),etomidate 0.28±0.12mg/kg (groupB),propofol 2.10±0.28mg/kg(groupC).All the patients were supplemented with midazolam 0.1～0.2mg/kg,innvor 2～3ml during the tracheotomy.Heart rate(HR),mean arteral pressure(MAP),respiration rate(RR) and SpO_2 were monitored before and after induction and immediately after intubation.Results: In group A,RR was found decreasd in 18 patients,, SpO_2 lowed and MAP increasd markedly(P<0.01). In group B, HR, MAP and RR had not significant difference with those before induction.In group C,MAP was significantly decreasd(P<0.01),SpO_2 lowed slightly but was still in normal range.Conclusion: Etomidate and propofol are suitable for induction in the intubation in tracheotomy with controlled dosage and infusion speed.

关 键 词：羟丁酸钠 依托咪酯 二异丙酚 麻醉药 局部 喉颈联合手术 

分 类 号：R971[医药卫生—药品]