目的 探讨对中重度气道狭窄患者行硬质气管镜检查治疗中无肌松药静脉麻醉的应用效果。方法 选择2020-01至2021-01应急总医院拟行硬质气管镜检查治疗的中重度气道狭窄患者60例,按照随机数字表法分为无肌松药组(A组)和肌松药组(B组),每组30例。两组常规进行麻醉,B组待患者意识消失后,在插管前给予罗库溴铵0.3 mg/kg;A组不给予罗库溴铵。比较两组患者麻醉诱导前(T0)、置入硬镜时(T1)、置入硬镜后(T2)的平均动脉压(mean arterial press,MAP)、心率(heart rate,HR)、脑电双频指数(bispectral index,BIS)值,置入硬镜时患者声门活动,置入硬镜后患者呛咳、手术时间、苏醒时间、术毕动脉血气分析、术中血氧饱和度低于90%及上肢肌力评测情况。结果 共53例完成本研究,其中A组27例,B组26例。两组患者置入硬镜前后MAP、HR变化差值、手术时间、苏醒时间差异无统计学意义。A组乳酸(lactic,Lac)[(1.05±0.4)mmol/L]高于B组[(0.8±0.3)mmol/L],差异有统计学意义(P<0.05)。两组患者声带活动及术中低氧血症发生率差异无统计学意义,但A组呛咳发生率(66.6%)明显高于B组的19.2%,A组苏醒时上肢肌力对抗阻力为100.0%,明显好于B组(46.1%),两组对比,差异有统计学意义(P<0.05)。结论 采用无肌松药静脉麻醉对中重度气道狭窄患者行硬质气管镜检查治疗,患者肌力恢复好,对呼吸功能影响较小。
Abstract
Objective To evaluate the effect of no-inotropic intravenous anesthesia in the treatment of patients with moderate-to-severe airway stenosis through rigid bronchoscopy.Methods Sixty patients with moderate-to-severe airway stenosis from January 2020 to January 2021 treated through rigid bronchoscopy were randomly divided into no-inotropic group (group A) and the inotropic group (group B). We measured the mean arterial pressure (MAP), heart rate (HR), Bispectral index values (BIS) before induction of anesthesia (T0), at the time of rigidoscopy placement (T1), and after rigidoscopy placement (T2); vocal activity of patients at the time of rigidoscopy placement , choking of patients after rigidoscopy placement, operation time, awakening time, arterial blood gas analysis at the end of operation, intraoperative oxygen saturation below 90% , and the assessment of upper limb muscle strength were also measured.Results 53 patients completed the study, including 27 in the no-myorelaxant group and 26 in the myorelaxant group. There was no difference in the changes of MAP and HR between the two groups before and after rigidoscopy placement and there was no significant difference in operation time and awakening time. The blood gas analysis of lactate (Lac) was higher in group A(1.05±0.4)than in group B(0.8±0.3)(P<0.05). The difference in the incidence of intra operative hypoxemia between the two groups was not statistically significant. The incidence of choking was higher in group A 66.6% than in group B 19.2% (P< 0.05). The upper limb muscle strength against resistance at awakening was significantly better in group A 100% than in group B 46.1% (P<0.05).Conclusions No-inotropic intravenous anesthesia is a safe and feasible technique worth promoting because of the good recovery of patients' muscle strength and the low impact on respiratory function during rigid bronchoscopy treatment in patients with moderate to severe airway stenosis.
关键词
硬质气管镜 /
气道狭窄 /
无肌松 /
罗库溴铵 /
静脉麻醉 /
肌力评测
Key words
rigid bronchoscopy /
airway stenosis /
no-inotropic /
rocuronium bromide /
intravenous anesthesia /
dynamometry
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基金
贵州省科技计划项目(黔科合基础:20171107)
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