靶控输注麻醉诱导方式下静脉注射罗库溴铵时的气管插管时机  

Ideal timing for intubation after rocuronium administration during target-controlled infusion

作　　者：张广防[1] 曾朝坤[1] 洪庆雄[1] 古妙宁[2] 

机构地区：[1]广东省中医院麻醉科,广东广州510120 [2]南方医科大学南方医院,广东广州510515

出　　处：《现代医学》2012年第6期631-635,共5页Modern Medical Journal

摘　　要：目的:观察靶控输注异丙酚、瑞芬太尼麻醉诱导方式下静脉注射罗库溴铵后1、1.5、2、3 min时的气管插管条件,探讨理想的气管插管时机。方法:选取择期全麻手术患者60例,年龄18～60岁,ASAⅠ～Ⅱ级。根据肌松药注射后气管插管时间随机分为T1 min组、T1.5 min组、T2 min组、T3 min组,每组15例。以异丙酚和瑞芬太尼效应室靶质量浓度分别为3.0～4.0μg.ml-1和4 ng.ml-1,行麻醉诱导,注射罗库溴铵(0.9 mg.kg-1)后分别于预设时间行气管插管。记录诱导、插管过程中的心率(HR)、收缩压(SBP)、脑电双频指数(BIS值)以及各组气管插管条件评分和声门暴露程度。结果:T1.5 min组、T2 min组、T3 min组声门完全暴露率优于T1 min组(P<0.05),T1.5 min组、T2 min组、T3 min组之间比较差异无统计学意义。气管插管条件评分4组间比较差异无统计学意义。4组HR、SBP和BIS值诱导期均有明显差异(P<0.05),T1 min组SBP升高程度大于其余3组(P<0.05)。结论:罗库溴铵给药后1.5～3 min比1 min时气管插管条件更满意,是该药在靶控输注异丙酚、瑞芬太尼诱导方式下理想的气管插管时机。Objective： To define the ideal timing for intubation after rocuronium administration during target- controlled infusion （TCI） of propofol and remifentanil. Methods： Sixty consenting ASA Ⅰ or Ⅱ patients aged 18-60 years undergoing elective surgery under general anesthesia were randomly divided into 4 groups （n = 15 each） according to the intubation time after administration of the muscle relaxant. Anesthesia was induced with propofol and remifentanil and both of them were given by TCI. The target effect site concentration of propofol was set at 3.0- 4. 0 μg · ml -1 and that of remifentanil at 4 ng · m1-1. A senior anesthesiologist performed the intubations at 1, 1.5, 2 or 3 min after injection of rocuronium. HR, SBP and bispectral index （BIS） were monitored during induction and intubation. The glottic exposure was evaluated with Cormack-Lehane classification and the intubation conditions assessed according to Coooer＇s score. Results. There were no statisticallv significantdifferences with the vocal cord conditions （Cormack-Lehane score） in groups T1.5 min, T2 min and T3 min, but the vocal cord conditions at 1.5- 3 min differed significantly from that at 1 min after rocuronium administration （ P 〈 0.05）. There were no statistically significant differences in acceptable intubation conditions among the 4 groups. HR and SBP increased significantly after tracheal intubation in all groups （ P 〈 0. 05 ）, the increase in SBP in group T1min was significantly larger than that in other 3 groups （ P 〈 0.05 ）. Conclusion： The condition can be more suitable for intubation at 1.5-3 min than that at 1 min after rocuronium administration as the ideal timing for intubation during target-controlled infusion of propofol and remifentanil.

关 键 词：靶控输注 罗库溴铵 异丙酚 瑞芬太尼 气管插管条件 声门暴露程度 

分 类 号：R614.24[医药卫生—麻醉学]