纤支镜清醒插管时3种诱导方式对血液动力学反应的比较  

Comparison of three topical anesthesia for hemodynamic responses in use of bronchofibroscopy intubation

作　　者：孙志华[1] 刘展梅[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第5期760-762,共3页China Journal of Modern Medicine

摘　　要：目的比较声门表面麻醉、小剂量咪唑安定静脉注射复合声门表面麻醉、经环甲膜穿刺声门下复合声门表面麻醉对清醒患者经鼻纤维支气管镜插管血液动力学反应的影响。方法择期清醒状态行纤维支气管镜插管后全麻下口腔外科手术患者60例,ASAⅠ或Ⅱ级,年龄18～59岁。随机分为3组(n=20):声门表面麻醉组(B组);小剂量咪唑安定静脉注射复合声门表面麻醉组(M组);经环甲膜穿刺声门下复合声门表面麻醉组(H组)。纤维支气管镜插管前5min充分声门表面麻醉。M组再静脉注射咪唑安定0.04mg/kg,H组经环甲膜穿刺声门下气管内注射2%利多卡因2mL。记录基础值、插管前、纤维支气管镜引导光源进入声门、气管导管进入声门即刻的BP、HR、ECG和SpO2;计算各对应点的HR和收缩压(SBP)的乘积RPP;记录观察期血压和HR的最大值;记录患者是否有插管反应。结果与基础值相比较,插管前5min,M组血压、HR和RPP均降低(P<0.05),B组和H组保持稳定;在纤维支气管镜引导光源入声门和气管导管入声门即刻,H组血压、HR和RPP保持稳定,B组血压、HR和RPP均升高(P<0.05),M组HR和RPP均升高(P<0.05)。与B组相比较,插管前5min,M组血压、HR和RPP均降低(P<0.05);在纤维支气管镜引导光源入声门和气管导管入声门即刻,M组HR和RPP较B组低(P<0.05),H组血压、HR和RPP较B组明显低(P<0.05)。与H组相比较,插管反应发生的人数B组和M组更多(P<0.05)。结论经环甲膜穿刺用2%利多卡因2mL气管内表面麻醉复合声门处表麻组能有效抑制纤维支气管镜经鼻引导气管插管时的血液动力学反应。【Objective】To compare the effects of three topical anesthesia for hemodynamic responses in use of bronchofibroscopy intubation.【Methods】Sixty ASA ⅠorⅡadults（31 males, 29 females） aged 18-59 years, weighing 43-79 kg scheduled for elective oral cavity surgery in use of bronchofibroscopy intubation under topical anesthesia were randomly allocated to one of 3 groups （n =20 each）： group Ⅰ throat and part trachea topical anesthesia （B）; groupⅡ midazolam （M）; group Ⅲ throat and trachea topical anesthesia （H）. Anesthesia was induced with midazolam 0.04 mg/kg in groupⅡ, 2% lidocaine 2 mL trachea topical anesthesia was given by thyrocricocenlesis in group Ⅲ. Noninvasive BP and HR were record and RPP （SBP×HR） was calculated before baseline and immediately intubation during bronchofibroscopy intubation and tracheal intubation. 【Results】BP, HR and RPP were significantly decreased after induction of anesthesia as compare to baseline values in group M （P 0.05）, while they remained stable in group B and H. The bronchofibroscopy intubation responses were strongest in group B and M. But these responses were least in group H, SBP and HR reached their highest values significantly in group B than in group H and M. People of choking in group H is fewer than these of group B and M （P 0.05）.【Conclusion】2% lidocaine 2 mL Throat and trachea topical anesthesia can effectively inhibiting hemodynamic responses in use of bronchofibroscopy intubation.

关 键 词：支气管镜检查 酰胺类 局部麻醉 插管法 气管内 血液动力学现象 

分 类 号：R768.1[医药卫生—耳鼻咽喉科]