不同麻醉诱导气管插管在急性上消化道大出血内镜诊治中的应用效果比较  

Comparison of different anesthesia method-induced endotracheal intubation in endoscopic diagnosis and treatment of acute massive upper gastrointestinal hemorrhage

作　　者：李荣荣[1] 朱德冲 范志宁 周素利 LI Rong-rong;ZHU De-chong;FAN Zhi-ning;ZHOU Su-li(Department of Anesthesiology,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China;不详)

机构地区：[1]南京医科大学第一附属医院麻醉科,江苏南京210029 [2]南京医科大学第一附属医院消化内镜科,江苏南京210029

出　　处：《中国临床研究》2022年第12期1680-1684,共5页Chinese Journal of Clinical Research

摘　　要：目的比较单纯瑞芬太尼和丙泊酚复合芬太尼在急性上消化道大出血内镜诊治行左侧卧位气管插管中的麻醉诱导效果。方法回顾分析2017年10月至2021年5月南京医科大学第一附属医院急性上消化道大出血内镜诊治行左侧卧位气管插管45例患者的临床资料。男31例,女14例,年龄25~65岁,BMI<30,ASAⅡ或Ⅲ级。根据麻醉诱导方案分为:A组(n=20)采用单纯瑞芬太尼诱导行左侧卧位气管插管;B组(n=25)采用丙泊酚复合芬太尼诱导行左侧卧位气管插管。临床采集数据包括患者诱导前(T_(0))、气管插管前即刻(T_(1))、气管插管后即刻(T_(2))3个时间点的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO_(2))值,比较两组呼吸抑制、气管插管并发症的发生率。结果与T_(0)比较,T_(1)时B组MAP明显降低(P<0.05),T_(2)时A组MAP明显升高(P<0.05),两组SpO_(2)均明显降低(P<0.05)。与A组比较,B组T_(1)、T_(2)时MAP、SpO_(2)均明显降低(P<0.05)。B组SpO_(2)<95%发生率明显高于A组(72.0%vs 15.0%,P<0.01)。气管插管并发症:B组误吸发生率明显高于A组(28.0%vs 0,P<0.05),但误吸程度轻微;两组均未发生吸入性肺炎及声嘶;两组术后咽痛发生率差异无统计学意义(P>0.05)。结论两种麻醉诱导方法在急性上消化道大出血内镜诊治行左侧卧位气管插管中均可行;与丙泊酚复合芬太尼比较,单纯瑞芬太尼清醒气管插管能更有效地防止反流误吸及呼吸抑制,提供更稳定的血流动力学。Objective To compare the anesthetic induction effects of remifentanil alone and propofol combined with fentanyl in left lateral endotracheal intubation for endoscopic diagnosis and treatment of acute massive upper gastrointestinal hemorrhage.Methods A retrospective analysis was performed on the clinical data of 45 patients undergoing left lateral endotracheal intubation for endoscopic treatment of acute massive upper gastrointestinal bleeding in the First Affiliated Hospital with Nanjing Medical University from October 2017 to May 2021.There were 31 males and 14 females,aged 25-65 years,with BMI<30 and American Society of Anesthesiologists(ASA)physical status Ⅱ or Ⅲ.According to the method of anesthesia induction,the patients were divided into group A(with remifentanil alone used for induced intubation,n=20)and group B(with propofol-fentanyl for endotracheal intubation,n=25).Before induction(T_(0)),immediately before endotracheal intubation(T_(1))and immediately after endotracheal intubation(T_(2)),the values of heart rate(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO_(2))were recorded to compare the incidences of respiratory depression and endotracheal intubation-related complications between two groups.Results Compared with those at T_(0),MAP significantly decreased at T_(1)in group B(P<0.05)and significantly increased at T_(2)in group A(P<0.05),and SpO_(2)significantly decreased at T_(2)in both groups(P<0.05).Compared with those in group A,MAP and SpO_(2)significantly decreased at T_(1)and T_(2)in group B(P<0.05).The rate of SpO_(2)<95% in group B was significantly higher than that in group A(72.0%vs 15.0%,P<0.01).The incidence of aspiration in group B was significantly higher than that in group A(28.0%vs 0,P<0.05).The degree of aspiration was slight,and no aspiration pneumonia or hoarseness occurred in both groups.There was no significant difference in the incidence of postoperative sore throat and hoarseness between two groups(P>0.05).Conclusion In the endoscopic diagnosis and treatment

关 键 词：瑞芬太尼 麻醉诱导 左侧卧位 清醒气管插管 内镜 急性上消化道大出血 

分 类 号：R614[医药卫生—麻醉学] R573.2[医药卫生—外科学]