无肌松药气管插管预防急性颅内血肿清除术患者反流误吸的效果  

Efficacy of tracheal intubation without muscle relaxants in preventing reflux and aspiration in acute intracranial hematoma patients

作　　者：刘淑彬[1,2] 

机构地区：[1]泰山医学院附属新泰医院 [2]新泰市人民医院,山东新泰271200

出　　处：《基层医学论坛》2013年第1期8-10,共3页The Medical Forum

摘　　要：目的观察小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管预防急性颅内血肿清除术患者麻醉诱导期反流误吸的效果。方法 60例急性颅内血肿清除术患者随机分为试验组和对照组各30例,试验组依次缓慢静脉注射小剂量利多卡因-丙泊酚-瑞芬太尼完成麻醉诱导气管插管,不用肌松药及面罩加压给氧去氮;对照组常规全麻诱导气管插管。观察2组气管插管条件满意情况、气管插管前后血流动力学变化情况和反流误吸发生情况。结果 2组气管插管条件满意情况差异无统计学意义(P>0.05);试验组气管插管前即刻和气管插管后即刻平均动脉压(MAP)和心率(HR)与麻醉诱导前及与对照组比较均降低(P<0.05),但均在临床允许范围,无需处理;2组各时点指脉血氧饱和度(SpO2)比较差异无统计学意义(P>0.05),但对照组中发生误吸者气管插管前即刻和气管插管后即刻均降至90%以下;试验组1例反流,无误吸,对照组8例反流,3例误吸,2组比较差异有统计学意义(P<0.05)。结论小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管可有效预防急性颅内血肿清除术患者麻醉诱导期反流误吸,气管插管条件满意,血流动力学变化在临床允许范围,值得推广。Objective To investigate the efficacy of small-dose lidocaine-propofol-remifentanil tracheal intubation without muscle relaxants in preventing reflux and aspiration during anesthesia induction in acute intracranial hematoma patients. Methods 60 acute intracranial hematoma patients were randomly divided into 2 groups： Experimental group and the control group （n =30 each ）.Experimental group received lidocaine 1.5 mg/kg, propofol 1.Smg/kg and remifentanil 2 μg/kg, while the control group received general anesthesia induction. Tracheal intubation conditions, hemodynamic changes before and after tracheal intubation, reflux and aspiration during anesthesia induction were observed and recorded. Results The difference of tracheal intubation conditions between two groups was not statistically significant （P〉0.05）.The reduce of MAP and HR prior to tracheal intubation also after tracheal intubation in experimental group, compared with it before induction of anesthesia and compared with it at the same monument in the control group,was statistically significant （P〈0.05）,however,was in clinical allowed range.The difference of SpO2 between two groups was not statistically significant （P〉0.05）, but the SpO2 prior to tracheal intubation and after tracheal intubation of aspiration patients in the control group dropped to less than 90%. 1 cases of reflux and no aspiration were observed in experimental group, while 8 cases of reflux and 3 cases of aspiration in the control group, differences was statistically significant （P〈0.05）.Conclusion Small-dose lidocaine-propofol-remifentanil tracheal intubation without muscle relaxants could prevent reflux and aspiration during anesthesia induction in acute intracranial hematoma patients effectively, tracheal intubation conditions were satisfied, and hemodynamic changes were in clinical allowed range.

关 键 词：急性颅内血肿清除 气管插管 利多卡因 丙泊酚 瑞芬太尼 反流误吸 

分 类 号：R614[医药卫生—麻醉学]