CAJ | 학술논문

目的探讨静脉注射利多卡因对七氟醚复合瑞芬太尼无肌松药条件下气管插管效果的影响.方法气管插管全麻病人75例,年龄18～64岁,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将病人随机分为3组(n=25),A组:七氟醚+瑞芬太尼1 μg/kg;B组:七氟醚+瑞芬太尼1 μg/kg+利多卡因1 mg/kg;C组:七氟醚+瑞芬太尼2 μg/kg.吸入8%七氟醚2 min时,A组静脉注射瑞芬太尼1μg/kg,B组静脉注射瑞芬太尼1 μg/kg和利多卡因1 mg/kg,C组静脉注射瑞芬太尼2 μg/kg.瑞芬太尼注射完毕后行气管插管.从置入喉镜、声带位置、声带活动、咳嗽反射和体动反应5个方面评价气管插管条件,分为满意、良好和欠佳3个级别,记录各项满意的发生情况.于麻醉诱导前、气管插管前即刻和气管插管后即刻记录MAP和HR.结果病人均完成气管插管.与A组相比,B组和C组咳嗽反射的满意率升高,C组气管插管前即刻和气管插管后即刻MAP、HR降低(P＜0.05),B组气管插管前即刻和气管插管后即刻MAP和HR差异无统计学意义(P＞0.05);B组咳嗽反射的满意率较C组升高(P＜0.05).气管插管期间,C组有3例发生低血压,1例心动过缓,A组和B组均未见低血压或心动过缓发生.结论七氟醚复合瑞芬太尼用于无肌松药条件下气管插管时,静脉注射利多卡因1mg/kg不仅可优化气管插管条件,还可降低瑞芬太尼用量.
목적 탐토정맥주사리다잡인대칠불미복합서분태니무기송약조건하기관삽관효과적영향.방법기관삽관전마병인75례,년령18～64세,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장병인수궤분위3조(n=25),A조:칠불미+서분태니1 μg/kg;B조:칠불미+서분태니1 μg/kg+리다잡인1 mg/kg;C조:칠불미+서분태니2 μg/kg.흡입8%칠불미2 min시,A조정맥주사서분태니1μg/kg,B조정맥주사서분태니1 μg/kg화리다잡인1 mg/kg,C조정맥주사서분태니2 μg/kg.서분태니주사완필후행기관삽관.종치입후경、성대위치、성대활동、해수반사화체동반응5개방면평개기관삽관조건,분위만의、량호화흠가3개급별,기록각항만의적발생정황.우마취유도전、기관삽관전즉각화기관삽관후즉각기록MAP화HR.결과 병인균완성기관삽관.여A조상비,B조화C조해수반사적만의솔승고,C조기관삽관전즉각화기관삽관후즉각MAP、HR강저(P＜0.05),B조기관삽관전즉각화기관삽관후즉각MAP화HR차이무통계학의의(P＞0.05);B조해수반사적만의솔교C조승고(P＜0.05).기관삽관기간,C조유3례발생저혈압,1례심동과완,A조화B조균미견저혈압혹심동과완발생.결론 칠불미복합서분태니용우무기송약조건하기관삽관시,정맥주사리다잡인1mg/kg불부가우화기관삽관조건,환가강저서분태니용량.
Objective To investigate the effect of intravenous lidocaine on the efficacy of sevoflurane combined with remifentanil for tracheal intubation without neuromuscular relaxants. Methods Seventy-five ASA Ⅰor Ⅱ patients, aged 18-64 yr, scheduled for elective surgery, needing tracheal intubation under general anesthesia, were randomly divided into 3 groups ( n = 25 each) : sevoflurane + remifentanil 1 μg/kg group (group A) ;sevoflurane + remifentanil 1 μg/kg + lidocaine 1 mg/kg group (group B); sevoflurane + remifentanil 2 μg/kg group (group C) . Two minutes after inhalation of 8% sevoflurane for anesthesia induction, remifentanil 1 μg/kg, remifentanil 1 μg/kg + lidocaine 1 mg/kg, and remifentanil 2 μg/kg were injected intravenously in groups A, B and C respectively. Tracheal intubation was performed after completion of remifentanil injection. Intubating conditions were assessed based on ease of laryngoscopy, position of vocal cords, activity of vocal cords, degree of coughing and limb movement. MAP and HR were also recorded before induction and immediately before and after intubation. Results Tracheal intubations were successful in all patients. The satisfactory rates of coughing were significantly higher in groups B and C, and MAP and HR were significantly lower immediately before and after intubation in group C than in group A ( P ＜ 0.05) . The satisfactory rate of coughing was significantly higher in group B than in group C ( P ＜ 0.05) . During intubation, 3 cases developed hypotension and 1 case bradycardia in group C. Conclusion When sevoflurane combined with remifentanil is used for tracheal intubation without neuromuscular relaxants, intravenous lidocaine 1 mg/kg can not only improve intubating conditions, but also decrease the consumption of remifentanil.