不同表面麻醉对清醒镇静慢诱导纤维支气管镜引导经鼻气管内插管术的效果比较  

Comparison of the effects of different surface anesthesia on conscious sedation and slow induction of fiberoptic bronchoscopy guided by nasal endotracheal intubation

作　　者：李明[1] 张帅文 朱雁鸿[1] 戴晓蓉[1] 

机构地区：[1]昆明医科大学附属六院,云南省玉溪市人民医院麻醉科,云南玉溪653100

出　　处：《中国实用医刊》2017年第24期87-90,共4页Chinese Journal of Practical Medicine

摘　　要：目的 比较不同表面麻醉在清醒镇静慢诱导纤维支气管镜引导经鼻气管内插管术的效果.方法 将46例ASAⅠ - Ⅱ级择期手术前可预期的困难气道患者,随机分为两组：组Ⅰ采用鼻腔联合纤维支气管镜喷洒表面麻醉,组Ⅱ采用鼻腔联合纤维支气管镜经导管喷洒表面麻醉.两组TCI至相同镇静深度后实施经鼻气管内插管.记录患者靶控输注（TCI）前（基础值）、达预计镇静评分（T 0）、插管即刻（T 1）、插管后1 min（T 2）各点心率（HR）、平均动脉压（MBP）、血氧饱和度（SpO 2）.记录支气管镜进鼻腔开始至插管过程的反应评分、耐管评分、插管时间,达预期镇静评分时丙泊酚效应室浓度,插管术者操作满意度、患者满意度、一次插管成功病例、辅助呼吸病例、血管药物干预治疗病例.结果 两组患者TCI达预期镇静评分及插管期间,HR、MBP、SpO 2在组间、时点间、组间·时点间交互作用比较差异未见统计学意义（P〉0.05）.HR、MBP随时间呈轻度下降趋势,在插管后1 min与基础值保持平稳,SpO 2插管即刻下降,随后恢复正常,HR、MBP、SpO 2均在正常范围内波动.两组CE值、插管时间比较差异均未见统计学意义（P〉0.05）,插管反应评分、耐管反应评分比较差异有统计学意义（P〈0.05）.两组插管成功率、辅助呼吸、血管药物干预治疗比较差异均未见统计学意义（P〉0.05）,操作满意度、患者满意度比较差异有统计学意义（P〈0.05）.结论 两种表面麻醉方法均适合清醒镇静慢诱导纤维支气管镜引导经鼻气管内插管.鼻腔联合纤维支气管镜经导管喷洒表面麻醉在插管反应、耐管反应、患者满意度方面更为理想.Objective To compare the effects of different surface anesthesia on conscious seda-tion and slow induction of fiberoptic bronchoscopy guided by nasal endotracheal intubation. Methods Forty-six patients with ASA Ⅰ - Ⅱ grade before the elective surgery expected difficult airway were randomly divided into two groups：group I used nasal cavity combined with fiberoptic bronchoscope to spray surface anesthesia,and group II used nasal cavity combined with fiberoptic bronchoscope to spray surface anesthesia through catheter. Nasal endotracheal intubation TCI to the same sedation depth were administered after. Before TCI （baseline）,predict the sedation score （T 0 ）,intubation immediately 1 ）,minute after intubation （T 2 ）,the levels of HR,MBP,SpO 2 were recorded. The bronchoscope in-to the nasal cavity to the intubation process response score,tube score,intubation time,the expected concentration of propofol at the desired sedation score,the satisfaction of operation,patient satisfaction,a successful case of intubation,assisted respiratory cases,and vascular drug intervention were recorded. Results There was no significant difference in HR,MBP or SpO 2 between the two groups（P 〉 0. 05）. HR,MBP decreased slightly with time,1 minute after intubation and remained stable with the base val-ue,SpO 2 intubation immediately decreased,then returned to normal,HR,MBP,SpO 2 were in the nor-mal range of fluctuations. There was no significant difference in CE value or intubation time between the （T two groups （P 〉 0. 05）,and there was significant difference in the score of intubation reaction and the score of tube resistance reaction （P 〈 0. 05）. There was no significant difference between the two groups in the success rate of intubation,assisted respiration or vascular drug intervention （P 〉 0. 05）,and the difference in operation satisfaction and patient satisfaction was significant （P 〈0. 05）. Conclusions Both the two surface anesthesia methods are suitable for conscious sedation and

关 键 词：清醒镇静 表面麻醉 导管注药 

分 类 号：R614[医药卫生—麻醉学]