CAJ | 학술논문

目的探讨改良快速顺序诱导(RSI)气管插管期间应激反应的影响。方法将60例择期行胃癌、结直肠癌根治术患者按全麻诱导方法不同随机均分为两组：改良RSI组和常规RSI组。记录两组患者麻醉诱导前(T1)、麻醉诱导后2 min(T2)、气管插管后1 min (T3)、气管插管后5 min (T4)患者的心率( HR)、平均动脉压( MAP)、血脉搏氧饱和度(SPO2)、动脉血氧分压( PaO2)和动脉血二氧化碳分压(PaCO2)，并于T1、T3、T4相应时点抽取静脉血样，测定血浆皮质醇和血糖的浓度。结果与T1时点比较，常规RSI组在T2时点MAP、HR明显下降(P<0.05)，而改良RSI组在T2时点MAP、HR无明显下降，差异无统计学意义；与T2时点比较，常规 RSI 组在 T3时点 MAP、HR 明显升高( P <0.05)，而改良RSI组在T3时点MAP、HR无明显升高；两组患者PaCO2和SPO2无明显改变；与改良 RSI组比较，常规RSI组PaO2在T2时点明显升高(P<0.05)，但麻醉诱导时间明显延长(P<0.05)，两组血浆皮质醇及血糖浓度各时点比较无明显升高。结论改良的RSI与常规的RSI比较血流动力学更平稳，气管插管应激反应轻。
목적탐토개량쾌속순서유도(RSI)기관삽관기간응격반응적영향。방법장60례택기행위암、결직장암근치술환자안전마유도방법불동수궤균분위량조：개량RSI조화상규RSI조。기록량조환자마취유도전(T1)、마취유도후2 min(T2)、기관삽관후1 min (T3)、기관삽관후5 min (T4)환자적심솔( HR)、평균동맥압( MAP)、혈맥박양포화도(SPO2)、동맥혈양분압( PaO2)화동맥혈이양화탄분압(PaCO2)，병우T1、T3、T4상응시점추취정맥혈양，측정혈장피질순화혈당적농도。결과여T1시점비교，상규RSI조재T2시점MAP、HR명현하강(P<0.05)，이개량RSI조재T2시점MAP、HR무명현하강，차이무통계학의의；여T2시점비교，상규 RSI 조재 T3시점 MAP、HR 명현승고( P <0.05)，이개량RSI조재T3시점MAP、HR무명현승고；량조환자PaCO2화SPO2무명현개변；여개량 RSI조비교，상규RSI조PaO2재T2시점명현승고(P<0.05)，단마취유도시간명현연장(P<0.05)，량조혈장피질순급혈당농도각시점비교무명현승고。결론개량적RSI여상규적RSI비교혈류동역학경평은，기관삽관응격반응경。
Objective To investigate the effect of modified rapid sequence induction(RSI) on induction of general anesthesia in the surgery. Methods 60 ASA I or II patients, aged 30~60 year, weighing 45~80 kg, scheduled for gastric cancer, colorectal cancer surgery under general anesthesia were randomly divided into two groups (n=30 each):modified RSI and conventional RSI. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SPO2 ), arterial partial pressure of (PaO2 ) and arterial carbondioxide partial pressure (PaCO2 ) were recorded at the time of pre-induction(T1 ), post-induction 2 min(T2 ), post-intubation 1 min (T3 ) and post-intuba-tion 5 min (T4 ) in two groups. Vein blood samples were taken for determination of plasma concentrations of cortisol (nmol/L) and blood glucose (mmol/L) at the time of T1 ,T3 and T4 . Results Compared with T1 , the MAP and HR were significantly decreased at T2 in group conventional RSI (P<0.05), while no significant decrease was ob-served in group modified RSI. Compared with T2 , the MAP and HR were significantly increased in group conven-tional RSI (P<0.05), with no significant decrease in group modified RSI. The PaO2 and PaCO2 were no statisti-cally significant in two groups. Compared with group modified RSI, PaO2 were significantly increased in group con-ventional RSI (P<0.05), but induction of anesthesia time was significantly prolonged(P<0.05). Plasma cortisol and blood glucose were of no significant difference in two groups at T1 , T3 and T4 . Conclusion The modified rap-id sequence induction has more hemodynamic stability and lower stress response during induction of general anes-thesia.