七氟烷慢诱导全身麻醉在阻塞性睡眠呼吸暂停综合征患者悬雍垂腭咽成形术中的应用  

Application of sevoflurance slow induction general anesthesia to uvulopalatopharyngoplasty in patients with obstructive sleep apnea syndrome

作　　者：张宇[1] 姚翊[1] 孔高茵[1] 

机构地区：[1]湖南省人民医院麻醉科,湖南长沙410005

出　　处：《现代医药卫生》2013年第1期1-3,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨七氟烷慢诱导全身麻醉气管插管在成年阻塞性睡眠呼吸暂停综合征(OSAS)患者悬雍垂腭咽成形术(UPPP)中应用的安全性与可行性。方法选择行UPPP的OSAS男性患者30例,按美国麻醉医师协会(ASA)分级Ⅱ～Ⅲ级,年龄35～48岁。随机分为两组(各15例):咪达唑仑复合瑞芬太尼组(MR组)和七氟烷组(S组)。MR组诱导采用1%丁卡因表面麻醉联合咪达唑仑50μg/kg、瑞芬太尼0.8μg/kg静脉滴注,S组诱导采用1%丁卡因表面麻醉联合6%七氟烷吸入麻醉。维持均采用瑞芬太尼0.08μg/(kg.h)静脉持续泵入。两组均在保留自主呼吸情况下先使用Macintosh喉镜显露声门,如Comack-Lehane分级小于3级,直接经鼻气管插管;Comack-Lehane分级大于或等于3级,盲探经鼻气管插管1次,如果失败改行纤维镜下经鼻气管插管。记录患者诱导前(T1)、插管前(T2)、插管时(T3)平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2),观察并记录两组诱导时间、插管次数以及诱导期间相关不良事件发生率。结果所有患者诱导插管过程中SpO2>95%。两组T1时MAP和HR比较,差异无统计学意义(P>0.05),MR组T2时MAP和HR较T1时明显下降(P<0.05),S组T2时HR较T1时明显下降(P<0.05),两组各时间点SpO2比较,差异无统计学意义(P>0.05)。S组诱导时间明显长于MR组(P<0.05),S组Macintosh喉镜明视气道Comack-Lehane分级优于MR组(P<0.05),S组一次性插管成功率明显高于MR组(P<0.05)。S组呼吸抑制、呛咳和躁动发生率明显低于MR组(P<0.05)。结论 6%七氟烷吸入麻醉复合1%丁卡因表面麻醉慢诱导应用于OSAS患者UPPP治疗,不仅可以妥善处理困难气道相关问题,并且血流动力学相对平稳,不良事件发生率低,是一种安全、可行的诱导方案。Objective To investigate the safety and feasibility of sevoflurane slow induction general anesthesia endotracheal intubation to uvulopalatopharyngoplasty（UPPP） in adult patients with obstructive sleep apnea syndrome（OSAS）.Methods 30 male cases of OSAS,ASA Ⅱor Ⅲ,aged 35-48 years,scheduled for UPPP,were selected and randomly divided into 2 groups（n=15）.The MR group was induced by 1% tetracaine（surface anesthesia）,midazolam 50 μg/kg and remifentanil 0.8 μg/kg in bolus.The S group was induced by 1% tetracaine（surface anesthesia） and 6% sevoflrane inhalation anesthsia.Maintenance adopted remifentanil 0.08 μg/（kg·h） by continuous intravenous pumping.Both groups remained the spontaneously breathing and were intubated by Macintosh laryngeal endoscope with nasotracheal tube.The mean arterial blood pressure（MAP）,heart rate（HR） and O2 saturation（SpO2） were recorded at the time points of T1（before anesthesia induction）,T2（before intubation） and T3（intubation）.The induction time,intubation times and the related adverse events during induction and intubation were observed and recorded.Results During the whole procedure of induction and intubation,SpO2 was more than 95% in both groups.MAP and HR at T1 in two groups had no statistical difference（P0.05）.MAP and HR at T2 in the MR group were significantly decreased compared with the basic value at T1（P0.05）.HR at T2 in the S group was significantly decreased compared with the basic value at T1（P0.05）.SpO2 at various time points had no statistical differences between two groups（P0.05）.The induction time in the S group was significantly longer than that in the MR group（P0.05）.The Comack-Lehane grade and the success rates of one time intubtion in the S group were statistically better than those in the MR group（P0.05）.The occurrence rates of respiratory suppression,bucking and dysphoria in the S group were significantly lower than those in the MR group（P0.05）.Conclusion Application of 6% sevoflurane in

关 键 词：睡眠呼吸暂停 阻塞性 睡眠呼吸暂停综合征 七氟烷 瑞芬太尼 插管法 气管内 麻醉 全身 慢诱导 

分 类 号：R766.43[医药卫生—耳鼻咽喉科]