非体外循环冠脉搭桥术中不同气管插管引导方法和去氧肾上腺素给予方式应用对比观察  

Comparison of different intubation guidance methods and phenylephrine administration approaches during off-pump coronary artery bypass grafting

作　　者：邢珍[1] 王丽[1] 汪业铭[1] 姚杰[1] 曹高亚 王新生[1] 李福龙[1] XING Zhen;WANG Li;WANG Yeming;YAO Jie;CAO Gaoya;WANG Xinsheng;LI Fulong(The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院,河北张家口075000 [2]河北医科大学第三医院

出　　处：《山东医药》2020年第36期29-32,共4页Shandong Medical Journal

基　　金：河北省重点研发计划自筹项目(162777173);河北省财政厅老年病防治项目。

摘　　要：目的对比观察三支血管病变冠心病患者非体外循环冠脉搭桥术中不同气管插管引导方法和去氧肾上腺素给予方式应用情况。方法60例非体外循环冠脉搭桥术患者随机分为4组各15例,FP组术中施行纤支镜引导气管插管+泵注去氧肾上腺素,LP组术中施行可视喉镜气管插管+泵注去氧肾上腺素,F组术中施行纤支镜引导气管插管+静注去氧肾上腺素,L组术中施行可视喉镜气管插管+静注去氧肾上腺素,比较各组麻醉诱导前(T_(0))、插管前即刻(T_(1))、插管后1 min(T_(2))、插管后3 min(T_(3))、插管后5 min(T_(4))的心率(HR)、MAP、RPP、动脉乳酸及诱导期时间、去氧肾上腺素使用量和T_(0)、T_(1)、T_(3)时点血浆去甲肾上腺素(NE)。结果与T_(1)时点比较,L组和LP组T_(2)、T_(3)时点的MAP、HR、RPP升高(P均<0.05)。与L组、F组比较,LP组和FP组麻醉诱导至插管时间缩短,去氧肾上腺素用量明显减少(P均<0.05)。与T_(1)时点比较,LP组和L组T3时点血浆NE水平升高(P均<0.05)。结论可视喉镜气管插管可引起冠心病三支病变患者血压升高心率增快,心肌耗氧增多;纤支镜引导气管插管刺激小,未增加心肌耗氧;间断推注去氧肾上腺素可延长诱导至插管时间,对患者不利;而纤支镜引导气管插管联合小剂量去氧肾上腺素持续泵注更有利于血流动力学平稳,尤其适合于心肌贮备较差的冠心病三支病变患者。Objective To investigate the optimal intubation guidance method and the choice of phenylephrine administration approaches for patients with three-vessel coronary heart disease undergoing off-pump coronary artery bypass grafting(CABG).Methods Sixty patients scheduled for off-pump CABG(49 males and 11 females,aged 52 to 75 years,ASAⅡ-Ⅲ)were randomly allocated into four groups,with 15 in each group:group L(intubation with visual laryngoscope+intravenous injection of phenylephrine),group LP(intubation with visual laryngoscope+continuous intravenous pumping of phenylephrine),group F(fiberoptic bronchoscope-guided intubation+intravenous injection of phenylephrine),and FP group(fiberoptic bronchoscope-guided intubation+continuous intravenous pumping of phenylephrine).The heart rate(HR),MAP,and RPP(RPP=SBP×HR)were recorded before anesthesia induction(T_(0)),immediately before intubation(T_(1)),1 minute after intubation(T_(2)),3 minutes after intubation(T_(3)),5 minutes after intubation(T_(4))as well as arterial lactic acid and time from anesthesia induction to intubation,and phenylephrine usage;plasma norepinephrine(NE)concentrations were measured at T_(0),T_(1) and T_(3).Results Compared with T_(1),the MAP,HR,and RPP of patients in the group L and LP group increased significantly at T_(2) and T_(3)(all P<0.05).The time from anesthesia induction to intubation was significantly shorter and the dosage of phenylephrine was less in the LP group and FP group than in the group L and group F(all P<0.05).The interplasma concentration of NE in the group L and LP group increased significantly at T_(3) as compared with that at T_(1).Conclusions Intubation with visual laryngoscope can cause the elevation of blood pressure,heart rate and myocardial oxygen consumption in patients with three-vessel coronary heart disease.The stimulation of intu-bation guided by fiberoptic bronchoscope is small and does not increase myocardial oxygen consumption.Intermittent injection of phenylephrine can prolong anesthesia induction time,which is

关 键 词：气管插管 非体外循环冠脉搭桥术 去氧肾上腺素 纤维支气管镜 可视喉镜 

分 类 号：R541.4[医药卫生—心血管疾病]