下载文档原格式
丙泊酚靶控输注和间断推注在改良喉罩全麻无痛纤支镜检查中的应用宋进;雷勇静;杜筱玲【摘要】目的:比较丙泊酚靶控输注和间断推注在改良喉罩全麻纤支镜检查中的应用效果,探讨合理用药方式.方法:ASA Ⅰ~Ⅱ级拟行纤支镜检查病人40例,随机分为间断推注组(A组)和靶控输注组(B组),每组20例.两组病人麻醉诱导相同,置入改良喉罩后行手动辅助通气.纤支镜检查期间A组病人发生4级体动时推注丙泊酚0.5 mg/kg.B组喉罩置入后设初始血浆靶浓度3 μg /ml,发生4级体动时靶浓度增加0.5 μg /ml,血压＜基础值20%则降低靶浓度0.5 μg /ml.记录麻醉前、睫毛反射消失、置入喉罩、纤支镜过声门、入声门后5 min和检查结束各时点的MAP、HR、SpO2,同时记录诱导、唤醒及定向力恢复时间,观察4级体动发生次数、丙泊酚追加次数、呛咳、呃逆以及低氧血症等发生情况.结果:A组检查中各时点MAP和HR 的波动较B组明显(P<0.05 );B组的唤醒时间、定向力恢复时间较A组短,而体动、呛咳、呃逆发生率以及追加丙泊酚的次数低于A组,组间差异均有统计学意义(P<0.05 ).结论:改良喉罩全麻纤支镜检查中,靶控输注丙泊酚具有血流动力学较稳定、苏醒快速、不良反应少的优点,是一种安全可行的给药方法.%Objective :To rompare the efficacy oi the proiile by applying improved laryngeal mask rombined with either infusion oi propoiol at discrete intervals or target-controlled infusion to analgesia in patients undergoing fiberoptic bronchoscopyt FOB ) for rational anesthetic dosage. Methods : Forty patients( ASA Ⅰ- Ⅱ) undergoing bronchofibroscopy were randomized into equal group A( infusion oi propoiol at discrete intervals ) and groupB( target-controlled infusion oi propofol ) with similar anesthetic induction.Manually assisted ventilation was carried out in the two groups at placement oi the improved laryngeal mask. Patients in group A were managed with infusion oi propoiol in dose oi 0. 5 mg/kg during the proce dure at body response by stage Ⅳ. In group B,the target plasma concentration oi propoiol was initially set at 3 μg/ml after successful placement oi the laryngeal mask and increased by 0. 5 μg /ml at body response by stage Ⅳ , whereas decreased by 0.5 μg /m l upon 20% fall of the basic value of blood pressure. Mean arterial pressure( MAP ),heart rate( HR ) and SpO2 were maintained at the time points of prior to anesthesia, loss of eyelash reflex,placement of laryngeal mask , bronchofibioscope through the vocal cords,live minutes after bronchofibioscope passage down the vocal cords and completion oi check-up. Records were also kept concerning the induction time, awakening from anesthesia, duration oi orientation force recover-y,frequencies oi body response at s tage Ⅳ, extra dosage oi propoiol and occurrences oi bucking, hiccupping and hypoxemia. Results: The fluctuation oi MAP and HR dining the procedure was more significant in group A compared to group B( P < 0. 05 ), whereas the group B had shorter time for awakening and recovery of the orientation force, lower incidences of body response, bucking and hiccoughing and less dose requirement oi additional propoiol. The two groups were statistically different ( P < 0. 05 ). Conclusion : Application oi improved laryngeal mask with target-controlled infusion oi propoiol to fiberoptic brohchoscopy may ensure stable hemodynamics and early awakening irom anesthesia, yetproduce less adverse eiiects, suggesting that this proiile is a safe recommendation in clinic.【期刊名称】《皖南医学院学报》【年(卷),期】2013(032)001【总页数】4页(P49-52)【关键词】喉罩;异丙酚;间断推注;靶控输注;纤维支气管镜检查【作者】宋进;雷勇静;杜筱玲【作者单位】芜湖市第二人民医院,麻醉科,安徽,芜湖,241000【正文语种】中文【中图分类】R614.2纤维支气管镜检查术是呼吸道疾病诊断和治疗的重要手段之一［1］，传统的纤维支气管镜检查方式是在咽部作局部喷雾表面麻醉，患者在清醒状态下接受检查，易出现生理、心理不适，影响检查质量，多数受检者不愿意接受再检查［2］。
