CAJ | 학술논문

目的观察小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管预防急性颅内血肿清除术患者麻醉诱导期反流误吸的效果.方法60例急性颅内血肿清除术患者随机分为试验组和对照组各30例,试验组依次缓慢静脉注射小剂量利多卡因-丙泊酚-瑞芬太尼完成麻醉诱导气管插管,不用肌松药及面罩加压给氧去氮;对照组常规全麻诱导气管插管.观察2组气管插管条件满意情况、气管插管前后血流动力学变化情况和反流误吸发生情况.结果2组气管插管条件满意情况差异无统计学意义(P>0.05);试验组气管插管前即刻和气管插管后即刻平均动脉压(MAP)和心率(HR)与麻醉诱导前及与对照组比较均降低(P<0.05),但均在临床允许范围,无需处理;2组各时点指脉血氧饱和度(SpO2)比较差异无统计学意义(P>0.05),但对照组中发生误吸者气管插管前即刻和气管插管后即刻均降至90%以下;试验组1例反流,无误吸,对照组8例反流,3例误吸,2组比较差异有统计学意义(P<0.05).结论小剂量利多卡因-丙泊酚-瑞芬太尼无肌松药气管插管可有效预防急性颅内血肿清除术患者麻醉诱导期反流误吸,气管插管条件满意,血流动力学变化在临床允许范围,值得推广.
목적관찰소제량리다잡인-병박분-서분태니무기송약기관삽관예방급성로내혈종청제술환자마취유도기반류오흡적효과.방법60례급성로내혈종청제술환자수궤분위시험조화대조조각30례,시험조의차완만정맥주사소제량리다잡인-병박분-서분태니완성마취유도기관삽관,불용기송약급면조가압급양거담;대조조상규전마유도기관삽관.관찰2조기관삽관조건만의정황、기관삽관전후혈류동역학변화정황화반류오흡발생정황.결과2조기관삽관조건만의정황차이무통계학의의(P>0.05);시험조기관삽관전즉각화기관삽관후즉각평균동맥압(MAP)화심솔(HR)여마취유도전급여대조조비교균강저(P<0.05),단균재림상윤허범위,무수처리;2조각시점지맥혈양포화도(SpO2)비교차이무통계학의의(P>0.05),단대조조중발생오흡자기관삽관전즉각화기관삽관후즉각균강지90%이하;시험조1례반류,무오흡,대조조8례반류,3례오흡,2조비교차이유통계학의의(P<0.05).결론소제량리다잡인-병박분-서분태니무기송약기관삽관가유효예방급성로내혈종청제술환자마취유도기반류오흡,기관삽관조건만의,혈류동역학변화재림상윤허범위,치득추엄.
Objective To investigate the efficacy of small-dose lidocaine-propofol-remifentanil tracheal intubation without muscle relaxants in preventing reflux and aspiration during anesthesia induction in acute intracranial hematoma patients. Methods 60 acute intracranial hematoma patients were randomly divided into 2 groups:Experimental group and the control group (n =30 each).Experimental group received lidocaine 1.5 mg/kg,propofol 1.5mg/kg and remifentanil 2μg/kg, while the control group received general anesthesia induction. Tracheal intubation conditions,hemodynamic changes before and after tracheal intubation,reflux and aspiration during anesthesia induction were observed and recorded. Results The difference of tracheal intubation conditions between two groups was not statistically significant (P>0.05).The reduce of MAP and HR prior to tracheal intubation also after tracheal intubation in experimental group, compared with it before induction of anesthesia and compared with it at the same monument in the control group,was statistically significant (P<0.05),however,was in clinical allowed range.The difference of SpO2 between two groups was not statistically significant(P>0.05),but the SpO2 prior to tracheal intubation and after tracheal intubation of aspiration patients in the control group dropped to less than 90%. 1 cases of reflux and no aspiration were observed in experimental group, while 8 cases of reflux and 3 cases of aspiration in the control group,differences was statistically significant (P<0.05).Conclusion Small-dose lidocaine-propofol-remifentanil tracheal intubation without muscle relaxants could prevent reflux and aspiration during anesthesia induction in acute intracranial hematoma patients effectively, tracheal intubation conditions were satisfied, and hemodynamic changes were in clinical allowed range.