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罗库溴铵在靶控输注麻醉时的气管插管时机
作者:张广防 曾朝坤 洪庆雄  
单位:广东省中医院
关键词:靶控输注 罗库溴铵  异丙酚  瑞芬太尼  气管插管条件  声门暴露程度 
分类号:
出版年·卷·期(页码):2012·40·第六期(631-635)
摘要:

目的 观察靶控输注异丙酚、瑞芬太尼麻醉诱导方式下静脉注射罗库溴铵后1、1.5、2、3min时的气管插管条件,探讨此条件下理想的气管插管时机。方法 60例择期全麻手术患者,年龄18~60岁,ASAⅠ~Ⅱ级,根据肌松药注射后气管插管时间随机分为T1min组、T1.5min组、T2min组、T3min组,每组15例。以异丙酚和瑞芬太尼效应室靶浓度分别为3.0~4.0µg/ml和4ng/ml行麻醉诱导,注射罗库溴铵(0.9mg/kg)后分别于预设时间行气管插管。记录诱导、插管过程中的HR、SBP、脑电双频指数(BIS值)以及各组气管插管条件评分和声门暴露程度。结果 T1.5min组、T2min组、T3min组声门完全暴露率优于T1min组(P<0.05),T1.5min组、T2min组、T3min组之间比较差异无统计学意义。气管插管条件评分四组间比较差异无统计学意义。四组HR、SBP和BIS值诱导期均有明显变化(P<0.05),T1min组SBP升高程度大于其余三组(P<0.05)。结论 罗库溴铵给药后1.5~3 min 比1 min 时气管插管条件更满意,是该药在靶控输注异丙酚、瑞芬太尼诱导方式下理想的气管插管时机。

Objective To define the ideal time occasion for intubation after rocuronium administration during target-controlled infusion (TCI) of propofol and remifentanil. Methods sixty consenting ASA Ⅰor Ⅱ patients aged 18~60 years undergoing elective surgery under general anesthesia were randomly divided into 4 groups (n=15 each) according to the intubation time after administration of the muscle relaxant. Anesthesia was induced with propofol and remifentanil and both of them were given by TCI. The target effect site concentration of propofol was set at 3.0~4.0µg/ml and that of remifentanil at 4 ng/ml. A senior anesthesiologist performed the intubations at 1, 1.5, 2 or 3 min after injection of rocuronium. HR, SBP and bispectral index (BIS) were monitored during induction and intubation. The glottic exposure was evaluated with Cormack-Lehane classification and the intubation conditions assessed according to Cooper's score. Results There were no statistically significant differences with the vocal cord conditions (Cormack-Lehane score) in groups T1.5min, T2min and T3min, but the vocal cord conditions at 1.5~3min differed significantly from that at 1 min after rocuronium administration (P<0.05). There were no statistically significant differences in acceptable intubation conditions and the intubation time among the 4 groups. HR and SBP increased significantly after tracheal intubation in all groups (P<0.05), the increase in SBP in group T1min was significantly larger than that in other 3 groups (P<0.05). Conclusion The condition can be more suitable for intubation at 1.5~3 min than that at 1 min after rocuronium administration as the ideal time occasion for intubation during target-controlled infusion (TCI) of propofol and remifentanil.

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