国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
11期
1012-1017
,共6页
Shikani喉镜%磨牙入路%经口气管插管%血流动力学
Shikani喉鏡%磨牙入路%經口氣管插管%血流動力學
Shikani후경%마아입로%경구기관삽관%혈류동역학
Shikani Optical Stylet%Molar approach%Orotracheal intubation%Hemodynamic responses
目的 研究视可尼(Shikani Optical Stylet,SOS)左侧磨牙入路、正中入路和右侧磨牙入路经口气管插管对血流动力学的影响.方法 选择92例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、年龄20岁～65岁,拟在经口气管插管全身麻醉下实施择期手术的患者,采用随机数字表法分为3组:左侧磨牙入路组(SL组,30例)、正中入路组(SM组,32例)和右侧磨牙入路组(SR组,30例).麻醉诱导后分别采用不同径路实施SOS经口气管插管操作,观察3组患者麻醉诱导前后、气管插管时和气管插管后5 min内的血压(blood pressure,BP)、心率(heart rate,HR)和二重指数(rate pressure product,RPP)的变化,并记录气管插管时间.结果 右侧磨牙入路经口气管插管的操作时间[(31±10)s]较左侧磨牙入路[(22±11)s]明显延长(P＜0.05).麻醉诱导后,3组患者的BP[SL组:(94±15) mmHg/(59±10) mmHg(1 mmHg=0.133 kPa);SM组:(95±17) mmHg/(56±9) mmHg;SR组:(102±14) mmHg/(58±9) mmHg]和RPP[SL组:7 125±1 826;SM组:7 127±1 826;SR组:7 326±1 621]均较麻醉诱导前[SL组:(132±11) mmHg/(72±9) mmHg;SM组:(135±11) mmHg/(72±6) mmHg;SR组:(136±14) mmHg/(71±1) mmHg;RPP:SL组:10 718±3 256;SM组:10 717±2 256;SR组:10 728±1 738]明显降低(P＜0.05).与麻醉诱导后[SL组:(194±15)mmHg/(159±10)mmHg,HR:(77±16)次/min;SM组:(95±17) mmHg/(56±9)mmHg,HR:(77±16)次/min;SR组:(102±14)mmHg/(58±9) mmHg,HR:(74±13)次/min; RPP:SL组:7 125±1 826;SM组:7 127±1 826;SR组:7 326±1 621]比较,气管插管后3组患者的BP[SL组:(110±19) mmHg/(68±16) mmHg;SM组:(107±18) mmHg/(69±13) mmHg;SR组:(125±16) mmHg/(75±10) mmHg]、HR[SL组:(93±13)次/min;SM组:(93±17)次/min;SR组:(87±13)次/min]和RPP(SL组:9 234±2 787;SM组:9 234±2 689;SR组:9772±1 885)明显升高(P＜0.05).与麻醉诱导前[SL组:(80±16)次/min;SM组:(79±9)次/min;SR组:(78±11)次/min]比较,3组患者气管插管后的HR[SL组:(93±13)次/min;SM组:(93±17)次/min;SR组:(87±13)次/min]明显升高(P＜0.05),且HR增快持续时间为1 min～3 min.与SL组[(110±19)mmHg]比较,SR组气管插管后即刻收缩压(systolic blood pressure,SBP)[(125±16) mmHg]明显升高(P＜0.05);与SM组[SBP:(107±18) mmHg;舒张压(diastolic blood pressure,DBP):(69±13) mmHg]比较,SR组气管插管后即刻SBP[(125±16) mmHg]、DBP[(75±10) mmHg]明显升高,且气管插管后5 min时间点的SBP[SM组:(98±14) mmHg;SR组:(106±15)mmHg]明显升高(P＜0.05).观察期SBP和HR变化率大于基础值30％的发生率在SL组分别为16.7％和46.7％,SM组分别为10％和50％,SR组分别为16.7％和33.3％,3组SBP大于基础值30％的发生率和RPP大于22 000的发生率差异无统计学意义,3组患者在气管插管开始后和气管插管完成后SBP和HR出现最大值的时间差异无统计学意义.结论 采用SOS经口不同径路气管插管时,左侧磨牙入路的操作时间最短;左侧磨牙入路和正中入路可引起类似的血流动力学反应,而右侧磨牙入路可引起较为剧烈的血液动力学反应.
目的 研究視可尼(Shikani Optical Stylet,SOS)左側磨牙入路、正中入路和右側磨牙入路經口氣管插管對血流動力學的影響.方法 選擇92例美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級、年齡20歲～65歲,擬在經口氣管插管全身痳醉下實施擇期手術的患者,採用隨機數字錶法分為3組:左側磨牙入路組(SL組,30例)、正中入路組(SM組,32例)和右側磨牙入路組(SR組,30例).痳醉誘導後分彆採用不同徑路實施SOS經口氣管插管操作,觀察3組患者痳醉誘導前後、氣管插管時和氣管插管後5 min內的血壓(blood pressure,BP)、心率(heart rate,HR)和二重指數(rate pressure product,RPP)的變化,併記錄氣管插管時間.結果 右側磨牙入路經口氣管插管的操作時間[(31±10)s]較左側磨牙入路[(22±11)s]明顯延長(P＜0.05).痳醉誘導後,3組患者的BP[SL組:(94±15) mmHg/(59±10) mmHg(1 mmHg=0.133 kPa);SM組:(95±17) mmHg/(56±9) mmHg;SR組:(102±14) mmHg/(58±9) mmHg]和RPP[SL組:7 125±1 826;SM組:7 127±1 826;SR組:7 326±1 621]均較痳醉誘導前[SL組:(132±11) mmHg/(72±9) mmHg;SM組:(135±11) mmHg/(72±6) mmHg;SR組:(136±14) mmHg/(71±1) mmHg;RPP:SL組:10 718±3 256;SM組:10 717±2 256;SR組:10 728±1 738]明顯降低(P＜0.05).與痳醉誘導後[SL組:(194±15)mmHg/(159±10)mmHg,HR:(77±16)次/min;SM組:(95±17) mmHg/(56±9)mmHg,HR:(77±16)次/min;SR組:(102±14)mmHg/(58±9) mmHg,HR:(74±13)次/min; RPP:SL組:7 125±1 826;SM組:7 127±1 826;SR組:7 326±1 621]比較,氣管插管後3組患者的BP[SL組:(110±19) mmHg/(68±16) mmHg;SM組:(107±18) mmHg/(69±13) mmHg;SR組:(125±16) mmHg/(75±10) mmHg]、HR[SL組:(93±13)次/min;SM組:(93±17)次/min;SR組:(87±13)次/min]和RPP(SL組:9 234±2 787;SM組:9 234±2 689;SR組:9772±1 885)明顯升高(P＜0.05).與痳醉誘導前[SL組:(80±16)次/min;SM組:(79±9)次/min;SR組:(78±11)次/min]比較,3組患者氣管插管後的HR[SL組:(93±13)次/min;SM組:(93±17)次/min;SR組:(87±13)次/min]明顯升高(P＜0.05),且HR增快持續時間為1 min～3 min.與SL組[(110±19)mmHg]比較,SR組氣管插管後即刻收縮壓(systolic blood pressure,SBP)[(125±16) mmHg]明顯升高(P＜0.05);與SM組[SBP:(107±18) mmHg;舒張壓(diastolic blood pressure,DBP):(69±13) mmHg]比較,SR組氣管插管後即刻SBP[(125±16) mmHg]、DBP[(75±10) mmHg]明顯升高,且氣管插管後5 min時間點的SBP[SM組:(98±14) mmHg;SR組:(106±15)mmHg]明顯升高(P＜0.05).觀察期SBP和HR變化率大于基礎值30％的髮生率在SL組分彆為16.7％和46.7％,SM組分彆為10％和50％,SR組分彆為16.7％和33.3％,3組SBP大于基礎值30％的髮生率和RPP大于22 000的髮生率差異無統計學意義,3組患者在氣管插管開始後和氣管插管完成後SBP和HR齣現最大值的時間差異無統計學意義.結論 採用SOS經口不同徑路氣管插管時,左側磨牙入路的操作時間最短;左側磨牙入路和正中入路可引起類似的血流動力學反應,而右側磨牙入路可引起較為劇烈的血液動力學反應.
목적 연구시가니(Shikani Optical Stylet,SOS)좌측마아입로、정중입로화우측마아입로경구기관삽관대혈류동역학적영향.방법 선택92례미국마취의사협회(ASA)분급Ⅰ～Ⅱ급、년령20세～65세,의재경구기관삽관전신마취하실시택기수술적환자,채용수궤수자표법분위3조:좌측마아입로조(SL조,30례)、정중입로조(SM조,32례)화우측마아입로조(SR조,30례).마취유도후분별채용불동경로실시SOS경구기관삽관조작,관찰3조환자마취유도전후、기관삽관시화기관삽관후5 min내적혈압(blood pressure,BP)、심솔(heart rate,HR)화이중지수(rate pressure product,RPP)적변화,병기록기관삽관시간.결과 우측마아입로경구기관삽관적조작시간[(31±10)s]교좌측마아입로[(22±11)s]명현연장(P＜0.05).마취유도후,3조환자적BP[SL조:(94±15) mmHg/(59±10) mmHg(1 mmHg=0.133 kPa);SM조:(95±17) mmHg/(56±9) mmHg;SR조:(102±14) mmHg/(58±9) mmHg]화RPP[SL조:7 125±1 826;SM조:7 127±1 826;SR조:7 326±1 621]균교마취유도전[SL조:(132±11) mmHg/(72±9) mmHg;SM조:(135±11) mmHg/(72±6) mmHg;SR조:(136±14) mmHg/(71±1) mmHg;RPP:SL조:10 718±3 256;SM조:10 717±2 256;SR조:10 728±1 738]명현강저(P＜0.05).여마취유도후[SL조:(194±15)mmHg/(159±10)mmHg,HR:(77±16)차/min;SM조:(95±17) mmHg/(56±9)mmHg,HR:(77±16)차/min;SR조:(102±14)mmHg/(58±9) mmHg,HR:(74±13)차/min; RPP:SL조:7 125±1 826;SM조:7 127±1 826;SR조:7 326±1 621]비교,기관삽관후3조환자적BP[SL조:(110±19) mmHg/(68±16) mmHg;SM조:(107±18) mmHg/(69±13) mmHg;SR조:(125±16) mmHg/(75±10) mmHg]、HR[SL조:(93±13)차/min;SM조:(93±17)차/min;SR조:(87±13)차/min]화RPP(SL조:9 234±2 787;SM조:9 234±2 689;SR조:9772±1 885)명현승고(P＜0.05).여마취유도전[SL조:(80±16)차/min;SM조:(79±9)차/min;SR조:(78±11)차/min]비교,3조환자기관삽관후적HR[SL조:(93±13)차/min;SM조:(93±17)차/min;SR조:(87±13)차/min]명현승고(P＜0.05),차HR증쾌지속시간위1 min～3 min.여SL조[(110±19)mmHg]비교,SR조기관삽관후즉각수축압(systolic blood pressure,SBP)[(125±16) mmHg]명현승고(P＜0.05);여SM조[SBP:(107±18) mmHg;서장압(diastolic blood pressure,DBP):(69±13) mmHg]비교,SR조기관삽관후즉각SBP[(125±16) mmHg]、DBP[(75±10) mmHg]명현승고,차기관삽관후5 min시간점적SBP[SM조:(98±14) mmHg;SR조:(106±15)mmHg]명현승고(P＜0.05).관찰기SBP화HR변화솔대우기출치30％적발생솔재SL조분별위16.7％화46.7％,SM조분별위10％화50％,SR조분별위16.7％화33.3％,3조SBP대우기출치30％적발생솔화RPP대우22 000적발생솔차이무통계학의의,3조환자재기관삽관개시후화기관삽관완성후SBP화HR출현최대치적시간차이무통계학의의.결론 채용SOS경구불동경로기관삽관시,좌측마아입로적조작시간최단;좌측마아입로화정중입로가인기유사적혈류동역학반응,이우측마아입로가인기교위극렬적혈액동역학반응.
Objective To compare the hemodynamic responses to orotracheal intubation with a Shikani Optical Stylet (SOS) using left molar approach,median approach and right approach.Method Ninety-two patients ASA physical status Ⅰ-Ⅱ,aged 20 y-65 y,scheduled for elective surgery under general anesthesia requiring orotracheal intubation were randomly allocated to three groups by the left molar approach (SL group),the median approach (SM group) or the right molar approach (SR group).After an intravenous anesthetic induction,the orotracheal intubation was performed using a SOS.Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction,immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted.Rate-pressure product(RPP) were calculated.Results As compared with SL group [(22± 11) s],the time to successful intubation in SR group[(31 ±10) s] is significantly longer(P＜0.05).After anesthetic induction,BP [SL group:(94±15)mmHg/(59±10) mmHg,SM group:(95±17)mmHg/(56±9) mmHg,SR group:(102±14) mmHg/(158±9) mmHg (1 mmHg=0.133 kPa)] and RPP [SL group:7 125±1 826,SM group:7 127±1 826;SR group:7 326±1 621] in the three groups decreased significantly compared with their preinduction values [SL group:(132±11) mmHg/(72±9) mmHg,SM group:(135± 11) mmHg/(72±6) mmHg,SR group:(136±14) mmHg/(71±11) mmHg; RPP:SL group:10 718±3 256,SM group:10 717±2 256,SR group:10 728±1 738](P＜0.05).As comparison with their postinduction values[SL group:(94±15) mmHg/(59±10) mmHg,HR:(77±16) beats/min; SM group:(95±17) mmHg/(56±9) mmHg,HR:(77±16) beats/min; SR group:(102±14) mmHg/(58±9) mmHg,HR:(74±13)beats/min,RPP:SL group:7 125±1 826,SM group:7 127±1 826,SR group:7 326±1 621],the orotracheal intubation in the three groups caused significant increases in BP [SL group:(110±19) mmHg/(68±16) mmHg,SM group:(107±18) mmHg/(69±13)mmHg,SR group:(125±16)mmHg/(75±10) mmHg],HR[SL group:(93±13) beats/min,SM group:(93±17) beats/ min,SR group:(87±13) beats/min] and RPP [SL group:9 234±2 787,SM group:9 234±2 689,SR group:9 772±1 885](P＜0.05).HR [SL group:(93±13) beats/min,SM group:(93±17) beats/min,SR group:(87±13) beats/min] of three groups after intubation were significantly higher than their baseline values[SL group:(80±16) beats/min,SM group:(79±9) beats/min,SR group:(78±11) beats/min] (P＜0.05),and the increase in HR lasted for 1 min-3 min.As compared with SL group [(110±19) mmHg],SBP immediately after intubation[(125±16) mmHg] was significantly higher in SR group(P＜0.05).As compared with SM group[systolic blood pressure(SBP):(107±18) mmHg,diastolic blood pressure(DBP):(69±13) mmHg],SBP[(125±16) mmHg] and DBP[(75± 10) mmHg]immediately after intubation and SBP at 5 min after intubation [SM group:(98±14) mmHg,SR group:(106±15) mmHg] in SR group were significantly higher(P＜0.05).The incidences of SBP and HR above 30％ of baseline value are 16.7％ and 46.7％ in SL group,10％ and 50％ in SM group,16.7％ and 33.3％ in SR group respectively.The incidences of SBP above 30％ of baseline value and RPP more than 22 000 were not significantly different.The occurrence time of SBP and HR maximum after intubation beginning and intubation completion were not significant among three groups.Conclusions The intubation time in SR group is shortest in three groups.The orotracheal intubation with SOS by the left molar approach and the median approach shows similar hemodynamic responses,orotracheal intubation with SOS by the right molar approach results in more severe hemodynamic responses.
