复合芬太尼时咪达唑仑用于慢诱导纤维支气管镜引导经鼻气管插管术适宜剂量探讨  

The optimal dose of midazolam combined with fentanyl for sedation during fiber-optic bronchoscopy-assisted nasotracheal intubation

作　　者：宋丽[1] 袁维秀[1] 米卫东[1] 

机构地区：[1]解放军总医院麻醉手术中心,北京100853

出　　处：《北京医学》2016年第2期144-146,共3页Beijing Medical Journal

摘　　要：目的探索复合芬太尼时咪达唑仑用于慢诱导纤维支气管镜(简称纤支镜,FOB)引导经鼻气管插管术的适宜剂量。方法拟经鼻行气管插管全麻的患者35例,年龄18~65岁,BMI 20~26 kg/m^2,入室后静脉注射咪达唑仑0.02 mg/kg、芬太尼1.5μg/kg,根据脑电双频指数(BIS)追加咪达唑仑,控制BIS值降至85时,行环甲膜穿刺术,控制BIS值降至80~70时,放置纤支镜,纤支镜进入声门后,静注丙泊酚1.0 mg/kg,同时送进气管导管。气管导管位置确认后开始全身麻醉。记录术中及术后情况,记录环甲膜穿刺时和放置纤支镜时咪达唑仑的累计用量。结果气管插管时间平均(60±5)s,气道阻塞发生率为14%,未发生严重低氧血症,患者舒适度为94%,知晓率为6%。环甲膜穿刺时咪达唑仑累计用量为0.03~0.04 mg/kg,放置纤支镜时咪达唑仑累计用量0.05~0.06 mg/kg。插管过程中循环有一过性波动。结论复合芬太尼1.5μg/kg,环甲膜穿刺时咪达唑仑累计用量0.03~0.04 mg/kg、放置纤支镜时咪达唑仑累计用量0.05~0.06 mg/kg用于慢诱导FOB经鼻气管插管是安全可行的,送入气管导管的同时静注丙泊酚1.0 mg/kg,可以避免患者不适和血流动力学波动。Objective To explore the optimal dose of midazolam combined with fentanyl for sedation during fiberoptic bronchoscopy（FOB）-assisted nasotracheal intubation. Methods Thirty-five patients aged 18~65 years, with BMI of20~26 kg/m2, underwent general anesthesia for fiber- optic bronchoscopy- assisted nasotracheal intubation. They received fentanyl 1.5 μ g/kg and midazolam 0.02 mg/kg after entering the operating room. Additional doses of midazolam were added according to bispectral index（BIS）. All patients received cricothyroid membrane puncture once BIS value decreased to85. FOB was placed as soon as BIS value was between 80~70. Propofol 1.0 mg/kg was injected after FOB passed the glottis and the tracheal tube was intubated at the same time. General anesthesia was commenced after the nasotracheal tube was secured. Intraoperative and postoperative events were recorded. The cumulative dose of midazolam at the time of cricothyroid membrane puncture and FOB placed were recorded, respectively. Results The intubation time was（60 ± 5） s,airway obstruction incidence was 14%, no severe hypoxemia happened. Patient comfort was 94%. The incidence of awareness of cricothyroid membrane puncture was 6%. The dose of midazolam was 0.03~0.04 mg/kg required for cricothyroid membrane puncture, the cumulative dosage was 0.05~0.06 mg/kg required for FOB placement. Conclusion 0.03~0.04mg/kg midazolam for cricothyroid membrane puncture and 0.05~0.06 mg/kg midazolam for the placement of FOB are safe and feasible during FOB-assisted nasotracheal intubation. Injection of propofol 1.0 mg/kg and nasotracheal intubation at the same time can prevent patients from discomfort and the fluctuation of hemodynamics.

关 键 词：咪达唑仑 纤维支气管支镜 插管 血流动力学 

分 类 号：R614[医药卫生—麻醉学]