中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
5期
629-631
,共3页
邵雪泉%余功敏%赵柯敏%兰允平%程李健%潘中心%郑丽花%徐惠胜
邵雪泉%餘功敏%趙柯敏%蘭允平%程李健%潘中心%鄭麗花%徐惠勝
소설천%여공민%조가민%란윤평%정리건%반중심%정려화%서혜성
麻醉药,吸入%咪达唑仑%呱啶类%插管法,气管内%纵隔肿瘤
痳醉藥,吸入%咪達唑崙%呱啶類%插管法,氣管內%縱隔腫瘤
마취약,흡입%미체서륜%고정류%삽관법,기관내%종격종류
Anesthetics,inhalation%Midazolam%Piperidines%lntubation,intracheal%Mediastiral neoplasms
目的 评价七氟醚-咪达唑仑-瑞芬太尼麻醉诱导用于纵膈巨大肿瘤患者无肌松药气管插管的可行性.方法 纵膈巨大肿瘤拟在全麻下手术患者22例,年龄22-64岁,体重48 ～ 76 kg,ASA分级Ⅰ-Ⅲ级.静脉注射咪达唑仑0.03 mg/kg,面罩吸入8％七氟醚,每30 s递减2％,直至4％,睫毛反射消失后,经1 min静脉注射瑞芬太尼2 μg/kg,30 s后停止吸入七氟醚,气管插管后行机械通气.于 麻醉诱导前、气管插管前即刻及插管后1 min时记录MAP和HR,记录睫毛反射消失时间,采用VibyMogensen评分法评价气管插管条件.结果 睫毛反射消失时间(110±14)s,一次气管插管成功率为86％,喉镜置入顺利,声门暴露基本良好,2例患者声门位置偏高,借助纤支镜引导下插管成功,气管插管条件优良率为86％.与麻醉诱导前比较,气管插管即刻、插管后1 min MAP、HR明显降低(p＜0.05),所有患者SpO＞95％,气管插管前至气管插管后1 min BIS值45 ～ 55.结论 七氟醚-咪达唑仑-瑞芬太尼麻醉诱导平稳,可提供良好的气管插管条件,适用于纵膈巨大肿瘤患者无肌松药气管插管,安全可行.
目的 評價七氟醚-咪達唑崙-瑞芬太尼痳醉誘導用于縱膈巨大腫瘤患者無肌鬆藥氣管插管的可行性.方法 縱膈巨大腫瘤擬在全痳下手術患者22例,年齡22-64歲,體重48 ～ 76 kg,ASA分級Ⅰ-Ⅲ級.靜脈註射咪達唑崙0.03 mg/kg,麵罩吸入8％七氟醚,每30 s遞減2％,直至4％,睫毛反射消失後,經1 min靜脈註射瑞芬太尼2 μg/kg,30 s後停止吸入七氟醚,氣管插管後行機械通氣.于 痳醉誘導前、氣管插管前即刻及插管後1 min時記錄MAP和HR,記錄睫毛反射消失時間,採用VibyMogensen評分法評價氣管插管條件.結果 睫毛反射消失時間(110±14)s,一次氣管插管成功率為86％,喉鏡置入順利,聲門暴露基本良好,2例患者聲門位置偏高,藉助纖支鏡引導下插管成功,氣管插管條件優良率為86％.與痳醉誘導前比較,氣管插管即刻、插管後1 min MAP、HR明顯降低(p＜0.05),所有患者SpO＞95％,氣管插管前至氣管插管後1 min BIS值45 ～ 55.結論 七氟醚-咪達唑崙-瑞芬太尼痳醉誘導平穩,可提供良好的氣管插管條件,適用于縱膈巨大腫瘤患者無肌鬆藥氣管插管,安全可行.
목적 평개칠불미-미체서륜-서분태니마취유도용우종격거대종류환자무기송약기관삽관적가행성.방법 종격거대종류의재전마하수술환자22례,년령22-64세,체중48 ～ 76 kg,ASA분급Ⅰ-Ⅲ급.정맥주사미체서륜0.03 mg/kg,면조흡입8％칠불미,매30 s체감2％,직지4％,첩모반사소실후,경1 min정맥주사서분태니2 μg/kg,30 s후정지흡입칠불미,기관삽관후행궤계통기.우 마취유도전、기관삽관전즉각급삽관후1 min시기록MAP화HR,기록첩모반사소실시간,채용VibyMogensen평분법평개기관삽관조건.결과 첩모반사소실시간(110±14)s,일차기관삽관성공솔위86％,후경치입순리,성문폭로기본량호,2례환자성문위치편고,차조섬지경인도하삽관성공,기관삽관조건우량솔위86％.여마취유도전비교,기관삽관즉각、삽관후1 min MAP、HR명현강저(p＜0.05),소유환자SpO＞95％,기관삽관전지기관삽관후1 min BIS치45 ～ 55.결론 칠불미-미체서륜-서분태니마취유도평은,가제공량호적기관삽관조건,괄용우종격거대종류환자무기송약기관삽관,안전가행.
Objective To evaluate the feasibility of induction with sevoflurane-midaaolam-remifentanil for tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.Methods Twenty-two ASA Ⅰ-Ⅲ patients with huge mediastinal tumor,aged 22-64 yr,weighing 48-76 kg,scheduled for surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midaaolam 0.03 mg/kg and inhalation of 8％ sevoflurane through a mask.Sevoflurane was inhaled at the initial concentration of 8％,followed by decrement of 2％ every 30 s until 4％.When the eyelash reflex disappeared,remifentani1 2 μ g/kg was injected slowly over I min and sevoflurane inhalation was stopped 30 s later.The patients were mechanically ventilated after tracheal intubation.MAP and HR were recorded before induction and immediately before and 1 min after inlubation.The time of disappearance of eyelash reflex was recorded.The inlubation condition was evaluated using VibyMogensen score.Results The time period from sevoflurane inhalation to disappearance of eyelash reflex was(110 ± 14)s.The success rate of tracheal intubation at the first attempt was 86％.The position of the glottis was higher in 2 patients,and tracheal intubation was successfully performed under the guide of fiberoptic bronchoscope.The satisfactory intubation conditions were found in 86％ of cases.Compared with that before anesthesia induclion,MAP and HR were significantly decreased immediately after intubation and at 1 min after intubation(P ＜ 0.05).SpO2 ＞ 95％ in all patients.BIS was maintained at 45-55 during the period(before intubation until 1 min after intubation).Conclusion Induction with sevoflurane-midazolam-remifenlail is rapid and smooth,provides good conditions for intubation and can be applied to tracheal intubation without muscle relaxants in patients with huge mediastinal tumor.
