CAJ | 학술논문

目的评价七氟烷-咪达唑仑-瑞芬太尼麻醉诱导用于患者无肌松药气管插管的效果.方法择期全麻手术患者30例,年龄20～55岁,体重50～80 kg,ASA Ⅰ或Ⅱ级.麻醉诱导:静脉注射咪达唑仑0.03 mg/kg,调节七氟烷挥发罐刻度至3%,氧流量5 L/min,预充呼吸环路30 s后,面罩吸入七氟烷,指导患者行肺活量呼吸,每呼吸3次,七氟烷挥发罐刻度增加1%,直至6%.待患者睫毛反射消失时,1 min内缓慢静脉注射瑞芬太尼2 μg/kg,30 s后停止吸入七氟烷,气管插管后行机械通气.于给药前、睫毛反射消失时、气管插管前即刻和气管插管后即刻,记录MAP、HR、SpO2和BIS;记录从开始吸入七氟烷到睫毛反射消失的时间;评估气管插管条件.结果所有患者一次性顺利完成气管插管,气管插管条件达优率为80%,从开始吸入七氟烷到睫毛反射消失的时间为(210±12)s.气管插管后即刻MAP、HR和SpO2与气管插管前即刻比较差异无统计学意义(P>0.05).气管插管前、后维持BIS 45～55.结论七氟烷-眯达唑仑-瑞芬太尼麻醉诱导平稳,可用于患者无肌松药气管插管.
목적 평개칠불완-미체서륜-서분태니마취유도용우환자무기송약기관삽관적효과.방법 택기전마수술환자30례,년령20～55세,체중50～80 kg,ASA Ⅰ혹Ⅱ급.마취유도:정맥주사미체서륜0.03 mg/kg,조절칠불완휘발관각도지3%,양류량5 L/min,예충호흡배로30 s후,면조흡입칠불완,지도환자행폐활량호흡,매호흡3차,칠불완휘발관각도증가1%,직지6%.대환자첩모반사소실시,1 min내완만정맥주사서분태니2 μg/kg,30 s후정지흡입칠불완,기관삽관후행궤계통기.우급약전、첩모반사소실시、기관삽관전즉각화기관삽관후즉각,기록MAP、HR、SpO2화BIS;기록종개시흡입칠불완도첩모반사소실적시간;평고기관삽관조건.결과 소유환자일차성순리완성기관삽관,기관삽관조건체우솔위80%,종개시흡입칠불완도첩모반사소실적시간위(210±12)s.기관삽관후즉각MAP、HR화SpO2여기관삽관전즉각비교차이무통계학의의(P>0.05).기관삽관전、후유지BIS 45～55.결론 칠불완-미체서륜-서분태니마취유도평은,가용우환자무기송약기관삽관.
Objective To evaluate the efficacy of induction with sevoflurane-midazolam-remifentanil for tracheal intubation without muscle relaxants.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 20-55 yr,weighing 50-80 kg,scheduled for elective surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and sevoflurane inhalation.Sevoflurane was inhaled initially with high-flow oxygen(5 L/min).Sevoflurane anesthetic vaporizer dial was set at 3% followed by increment of 1% every 3 times of respiration until 6% .When the patient's eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 1 min and 30 s later sevoflurane inhalation was then stopped.The patients were mechanically ventilated after tracheal intubation.MAP,HR,SpO2and BIS were recorded before administration,at the time of disappearance of eyelash reflex,immediately before tracheal intubatiun,and immediately after tracheal intobation.The time period from sevoflurane inhalation to disappearance of eyelash reflex was also recorded.Results All patients were successfully intubated at the first attempt.The satisfactory intubation conditions were found in 80% of cases.The time period from sevoflurane inhalation to disappearance of eyelash reflex was (210±12)s.MAP HR and SpO2remained stable and BIS value was maintained at 45-55 before and after tracheal intubation.Conclusion Induction with sevoflurane-midazolam-remifentanil is smooth and can be used for tracheal intubation without muscle relaxants.