七氟醚-咪达唑仑-瑞芬太尼麻醉诱导用于颈部制动患者无肌松药气管插管的可行性  

Feasibility of induction with sevoflurane-midazolam-remifentanil for tracheal intubation without muscle relaxants in neck brake patients

作　　者：邵雪泉[1] 潘中心[1] 兰允平[1] 徐玲[1] 占霖森[1] 杨淑芬[1] 余功敏[1] 黄莉[1] 郑丽花[1] 吴方璞[1] 

机构地区：[1]浙江省衢州市人民医院麻醉科,324000

出　　处：《中华麻醉学杂志》2010年第12期1435-1436,共2页Chinese Journal of Anesthesiology

基　　金：浙江省医学会临床科研基金项目（2009ZYC49）;浙江省医药卫生科学研究基金计划项目（2010KYB140）

摘　　要：目的 评价七氟醚-咪达唑仑-瑞芬太尼麻醉诱导用于颈部制动患者无肌松药气管插管的可行性。方法颈椎骨折伴脱位拟在全麻下手术患者40例，年龄13～68岁，ASA分级Ⅰ～Ⅲ级。静脉注射咪达唑仑0．03mg／kg，面罩吸入5％七氟醚，每30S递减1％，直至3％。待患者睫毛反射消失时，45S内缓慢静脉注射瑞芬太尼2μg／kg，30s后停止吸入七氟醚，气管插管后行机械通气。记录睫毛反射消失时间，采用Viby．Mogensen评分法评价气管插管条件。结果睫毛反射消失时间（69±4）s，一次气管插管成功率为100％，喉镜置入顺利，声门暴露基本良好。3例患者气管插管时出现轻微呛咳。气管插管条件优良率100％。所有患者sp02均〉95％，气管插管前至气管插管后3minBIS值40～55。结论七氟醚-咪达唑仑-瑞芬太尼麻醉诱导迅速而平稳，可提供良好的气管插管条件，适用于颈部制动患者无肌松药气管插管，安全可行。Objective To evaluate the feasibility of induction with sevoflurane-midazolam-remifentait for tracheal intubation without muscle relaxants in neck brake patients. Methods Forty ASA Ⅰ or Ⅱ patients with cervical spine fracture with dislocation, aged 13-68 yr, scheduled for surgery under general anesthesia, were enrolled in this study. Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and inhalation of 5% sevoflurane through a mask. Sevoflurane was inhaled at the initial concentration of 5 %, followed by decrement of 1% every 30 s until 3 % . When the eyelash reflex disappeared, remifentanil 2 μg/kg was injected slowly over 45 s and 30 s later sevoflurane inhalation was stopped. The patients were mechanically ventilated after tracheal intubation. The time of disappearance of eyelash reflex was recorded. The intubation condition was evaluated using Viby- Mogensen score. Results All patients were successfully intubated at the first attempt. The time period from sevoflurane inhalation to disappearance of eyslash reflex was （69 ± 4） s. Coughing occurred in 3 cases during intubation. The satisfactory intubation conditions were found in 100% of cases. SpO2 〉 95% in all patients. BIS was maintained at 45-55 during the period （before intubation until 3 min after intubation）. Conclusion Induction with sevoflurane-midazolam-remifentail is rapid and smooth, provides good conditions for intubation and can be applied to tracheal iutubation without muscle relaxants in neck brake patients.

关 键 词：麻醉药 吸入 咪达唑仑 哌啶类 插管法 气管内 颈部制动 

分 类 号：R614[医药卫生—麻醉学]