【摘要】 目的观察喉罩-瑞芬太尼复合异丙酚在无痛苦纤支镜检的应用效果。方法ASAⅠ~Ⅱ级拟行纤支镜检查的患者40例,随机分为喉罩组(L组,n=21)和表面麻醉组(T组,n=19)。麻醉诱导L组静脉依次给予异丙酚1~2mg/kg,瑞芬太尼1~3μg/kg后在喉镜辅助下置入喉罩,视情况间断推注异丙酚50mg维持麻醉;T组按常规表面麻醉后即行纤支镜检查。分别记录麻醉前(T0)、麻醉后纤支镜进入前(T1)、进镜至咽部(T2)、声门部(T3)、气管内(T4)及第15分钟(T5)时的血压(BP)、心率(HR)和动脉血氧饱和度(SpO2),观察镜检期间有无呛咳、气道痉挛或体动;记录停药至拔管的时间,麻醉满意度(由内镜医师评价)及麻醉再接受度(由患者评价)。结果L组患者术中血流动力学稳定,T组HR、MAP在各时点均升高,与T0比较差异有统计学意义(P<0.05),组间比较亦有统计学意义(P<0.05);L组患者镜检期间1例轻微呛咳,T组患者大部分均有呛咳、体动,其中有1例因不能耐受而中断检查;L组患者均能在术毕5~10min苏醒,麻醉满意度及患者再接受度均显著高于T组(P<0.01)。结论喉罩-瑞芬太尼复合异丙酚全麻用于无痛苦纤支镜检查,能保证稳定的血流动力学状态,苏醒快速,效果满意。更多还原

【Abstract】 Objective To assess the feasibility and safety of laryngeal mask combined with remifentanil-propofol anesthesia in painless fiberoptic bronchoscopy(FOB)check-up.Methods Forty ASA Ⅰ~Ⅱ patients scheduled to undergo fiberoptic bronchoscopy check-up were randomized divided into laryngeal mask airway(LMA) group(Group L)and topical anesthesia group(Group T).Propofol and remifentanil were infused in induction and maintenance of anesthesia in group L.All the patients in group T received topical anaesthesia with lidocaine 2%.Heart rate(HR)、non-invasive blood pressure(NIBP)and oxygen saturation by pulse oximeter(SpO2)were recorded at the following time points:before anaesthesia(baseline,T0)and immediately after anaesthesia induction(T1),when FOB at the level of pharynx(T2),vocal cords(T3),trachea(T4)and in 15 min of the FOB(T5).Laryngospasm and cough were observed at every time point.Extubation time、intra-operative satisfication(evaluated by Endoscopy Doctor)and post-operative complication(evaluated by patient)were also analyzed.Results The hemodynamics were stable in group L than in group T.Incidence of cough and body movements were obviously lower in group L than in group T.Intra-operative satisfication and post-operative complication were both higher in group L than in group T.Conclusion Under LMA ventilation,remifentanil combined with propofol resulted in more stable hemodynamics and smooth anesthesia than topical anaesthesia in painless fiberoptic bronchoscopy check-up.更多还原