七氟醚联合纤维支气管镜表面麻醉在困难气道插管中的应用  

Application of sevoflurane combined with surface anesthesia via fiberbronchoscope in difficult tracheal intubation

作　　者：徐亚杰[1] 王晓亮[1] 张勇[1] 谢欣怡[1] 鲍红光[1] 尹加林[1] XU Yajie;WANG Xiaoliang;ZHANG Yong;XIE Xinyi;BAO Hongguang;YIN Jialin(Department of Anesthesiology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院麻醉科

出　　处：《临床麻醉学杂志》2019年第12期1166-1169,共4页Journal of Clinical Anesthesiology

基　　金：南京市医学科技发展项目(YKK16141)

摘　　要：目的观察在困难气道患者中采用七氟醚联合纤维支气管镜(简称纤支镜)表面麻醉下保留自主呼吸气管插管的安全性及有效性。方法选择择期行手术治疗困难气道患者48例,男25例,女23例,年龄18~65岁,ASAⅠ或Ⅱ级,采用随机数字表法分为对照组(C组)和七氟醚组(S组),每组24例。两组患者均进行鼻腔准备,C组静脉输注右美托咪定负荷剂量1μg/kg且于15 min内输完,继以0.2μg·kg-1·h-1维持;采用纤支镜引导经鼻于咽部、声门上及声门周围各喷洒2%利多卡因2 ml,90 s后于声门下喷洒2%利多卡因2 ml,90 s后采用纤支镜引导经鼻气管插管。S组使用1%七氟醚预充呼吸回路后面罩吸入1%七氟醚开始诱导,每3次呼吸七氟醚浓度增加0.5%直至2.5%,采用上述纤支镜引导下局麻药喷洒方法行表面麻醉并进行插管。记录插管时间和插管一次成功率,入室后(T0)、气管导管进入鼻腔前(T1)、气管导管进入声门即刻(T2)、插管成功后5 min(T3)的SpO2、MAP、HR和Ramsay镇静评分;插管舒适度及随访不良反应情况。结果两组患者插管一次成功率均为100%,插管时间差异无统计学意义。T1-T2时S组Ramsay镇静评分明显高于C组(P<0.05);T2时S组MAP明显低于C组,HR明显慢于C组(P<0.05),且S组插管过程中舒适度评分和满意度评分明显低于C组(P<0.05)。C组气管插管过程中有1例呛咳,有4例出现体动且回访中2例诉咽痛,S组无一例不良反应,C组总的不良反应发生率明显高于S组(29%vs 0%,P<0.01)。结论七氟醚联合纤支镜引导下表面麻醉用于困难气道插管效果完善,可维持血流动力学平稳,降低围插管期不良反应,显著提高患者的满意度。Objective To observe the safety and efficacy of low concentration sevoflurane combined with surface anesthesia guided by fiberoptic bronchoscope intracheal intubation under spontaneous breathing for difficult airway patients. Methods Forty-eight patients with difficult airway, 25 males and 23 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, were divided into control group(group C) and sevoflurane group(group S) using random digital table. Group C received dexmedetomidine loading dose of 1 μg/kg in 15 min, maintained at a speed of 0.2 μg·kg-1·h-1. 2% lidocaine was sprayed on the glottis(2 ml) and supraglottis(2 ml) using fiberbronchoscope, followed by 2% lidocaine 90 s later sprayed on the infraglottic portion(2 ml), after 90 s, the fiberbronchoscope was used to guide the intubation. In group S, 1% sevoflurane was used to precharge respiratory loop, and sevoflurane induction began at the concentration of 1% and increased by 0.5% to 2.5% every 3 breaths, in this period, the patients′ Ramsay sedation score was maintained at 5 point. Adopting the above method, under surface anesthetic of local anesthetic spraying, the patients in group S were intubated under the guidance of fiberbronchoscope. Intubating time, SpO2, MAP, HR and Ramsay sedation score were recorded after entering the room(T0), before tracheal catheter into the oral cavity(T1), tracheal catheter into the glottis(T2), 5 min after intubation(T3). Intubation comfort and tracheal tube tolerance were recorded, and adverse reactions and follow-up records were filled. Results The successful rate of intubation in the two groups was 100%, and the time for intubation was not statistically significant. There was no significant difference in SpO2, MAP, HR and Ramsay sedation score at T0, T1 and T3 in the two groups. Compared with group C, the MAP and HR were significantly lower at T2 in group S, whereas Ramsay sedation score was significantly higher(P < 0.05). The intubation process was more comfortable, the tolerance after the intubation was better,

关 键 词：七氟醚 纤维支气管镜 经鼻气管插管 困难气道 

分 类 号：R614[医药卫生—麻醉学]