七氟烷或丙泊酚诱导用于纤维支气管镜引导下无肌松气管插管临床效果的比较

发布时间：2018-02-14 08:05

  本文关键词： 气管插管 纤维支气管镜 舒芬太尼 七氟烷 丙泊酚　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:比较利用七氟烷或者丙泊酚同时靶控输注舒芬太尼进行诱导后,在不给于肌松药的情况下,同时使用纤维支气管镜进行气管插管,观察其临床效果。方法:60个选择一定日期做手术的患者,年龄大约在18-65岁之间,体重与身高的平方之比在18.5-24之间,男病人与女病人比例没有要求,ASAⅠ-Ⅱ级,将病人速记分配到两个组内,分别是七氟烷组(S组)或者丙泊酚组(P)组,两个均即利用计算机控制泵入舒芬太尼,在利用纤维支气管镜的帮助下经过口腔来实施气管插管。所有病患在进入手术室以后,都无一例外的监测心电图,利用袖带记录血压(NBp),心率(HR),脉搏氧饱和度(Sp O2),护士进行输液,从开始到结束整个操作流程中输液的速度保持在4ml/min。给予咪达唑仑2mg,鼻导管(2L/min)吸氧5min,连接肌松监测仪。两个组都选择利用计算机控制输入舒芬太尼,并且选择效应室模式,在装置上按键选择性别,年龄,身高,体重,输入浓度为0.3ng/ml。丙泊酚也同时选择利用计算机泵入,选定起始浓度为3.5 ug/ml,开始后,利用面罩让病人吸氧,若诱导过程中Sp O290%,则先托起下颌,若Sp O2下降不能改善时,则辅助呼吸。七氟烷组选用潮气量法诱导,预先告知患者气体为有机溶剂的味道,将蒸发器和新鲜气流打为双8%,面罩紧紧扣住病人的脸面部,让患者做大口呼吸,直至患者没有意识,操作者很大声的叫唤也没有反应后,拨动患者睫毛也没有反应时,将蒸发器浓度调减低到4%,新鲜气流调到4 L/min,等待患者的下颌比较松,OAA/S≤2时,这个时候开始利用镜子实施插管。同时助手写下患者在刚刚进入室后(T0)、诱导前(T1)、诱导后(T2)、插管后即刻(T3)、插管后1min(T4)、插管后2min(T5)的血压(MAP)、心率(HR)、脉搏氧饱和度(Sp O2);及诱导前(T1),诱导后(T2),及插管后(T3)的TOF值(%);镜子进入的镜深度及管子插入的深度,诱导后OAA/S评分;记录插管及术后24h时不良反应发生率。结果:两组间比较,P组MAP在T2时较S组降低,HR在T2时、T3时、T4时、T5时较S组升高,意识消失与诱导时间较S组长,给麻黄碱例数较S组多(P0.05);两组的MAP、HR在其余各时间点差异均无统计学意义(P0.05),两组的插管时间,进镜及插管深度,给阿托品例数,TOF值,诱导后OAA/S评分,副作发生的情况方面统计学指标没有比较意义(P0.05)。与T1时比较,P组MAP在T2时、T3时降低,HR在T3时升高;S组MAP在T2时、T3时降低,HR在T2时升高(P0.05),其他各个时间点的不同性比较没有意义。结论:七氟烷与丙泊酚伍用舒芬太尼诱导均可安全用于全麻患者无肌松气管插管,为操作者提供较好的插管条件。
[Abstract]:Objective: To compare the use of seven halothane or propofol and sufentanil TCI were induced by not to muscle relaxant condition, at the same time using fiberoptic bronchoscope intubation, observe its clinical effect. Methods: 60 patients with certain date of surgery, age at about 18-65 years of age, and weight the square of the height ratio between 18.5-24, not the proportion of male patients and female patients, ASA I-II, were assigned to two groups respectively, were seven halothane group (S group) and propofol group (P group), two were namely the use of computer control in the infusion of sufentanil, the use of fiberoptic bronchoscopy to help after oral tracheal intubation. All patients in the operation room after all the ECG monitoring, record blood pressure cuff (NBp), heart rate (HR), pulse oxygen saturation (Sp O2), nurses from the infusion. Start to finish the whole operation process of infusion rate of midazolam administered 2mg in 4ml/min. (2L/min), nasal catheter oxygen 5min, connecting muscle relaxation monitor. The two groups were selected using computer control input and selection effect of sufentanil, room mode, the device select according to gender, age, height, weight. The input concentration of 0.3ng/ml. propofol also choose pump into computer use, selected initial concentration was 3.5 ug/ml, after the start, the use of oxygen masks allows patients during induction of Sp, if O290%, then Sp O2 chin, if the fall does not improve, then breathe. Seven halothane group were induced by the tidal volume, advance inform patients of organic solvent gas smell, and fresh air to the evaporator 8%, fasten the patient's face facial mask, so that patients do not breathe, until the patients consciousness, the operator call loudly 涔熸病鏈夊弽搴斿悗,鎷ㄥ姩鎮ｈ，

本文编号：1510243