速效药快速诱导插管在急症饱胃手术中的应用

目的探讨应用速效药快速诱导插管,无正压通气技术在急症饱胃手术中的可行性。方法总结25例急症饱胃患者手术快速诱导插管的经验,即诱导前面罩吸入纯氧5 min后,快速输注胶体300 ml扩容,采用威利方舟TCI-Ⅲ泵于90～120 s恒速泵入预算的丙泊酚和瑞芬太尼混合液。患者睫毛反射消失后静注司可林1.5 mg/kg,同时按压环状软骨,封闭食管,快速诱导期间不实施正压辅助通气。记录诱导用药前(T0)、用药毕(T1)、插管后即刻(T2)及成功5 min后(T3)的心率(HR)、血氧饱和度(SpO2)、血压、心电图(ECG),T2及T3的呼气末CO2分压(PET-CO2)。记录诱导过程中呛咳、呕吐、反流、误吸发生率。结果快速扩容提高了血流动力学的稳定性,预氧显著提高患者SpO2并达到了驱氮的效果。气管插管前后SpO2、BP、HR无显著变化;诱导及插管过程中无缺氧、反流和误吸发生,T2 PET-CO2升高,T3达到正常。结论对非困难气道、无严重心肺疾病的急症饱胃患者,应用速效药快速全麻诱导插管,应用预氧并无正压通气技术是安全、可行的。

Application of rapid sequence intubation induced by quick acting medicine in emergency full stomach surgery

Objective To evaluate the feasibility of rapid intubation induced by quick acting medicine without positive pressure ventilation in acute non-full stomach surgery. Methods 25 cases of emergency surgery in patients with full stomach and rapid intubation experience were summarized that inhalation of pure oxygen through mask was performed at 5min before induction,patients were received the rapid infusion of colloid 500ml for expansion and received the budgetary infusion of liquid mixture of propofol and remifentanil at constant speed of 90 to 120s by Willy's Ark TCI-Ⅲ pump.After eyelash reflex stopped,patients were treated with intravenous succinylcholine 1.5mg/kg,then the cricoid was pressed and the esophagus was closed at same time.Positive pressure ventilation was not used during rapid induction.T0 before induction treatment,T1 after treatment,T2 after intubation,5min after intubation T3's heart rate(HR),oxygen saturation of blood(SpO2),blood pressure,ECG,PET-CO2 of T2 and T3,and cough,vomiting,reflux,aspiration incidence during induction were recorded. Results Rapid expansion improved the hemodynamic stability,preoxygenation increased SpO2 in patients significantly with and achieved the disperse effect on nitrogen.Before and after tracheal intubation,SpO2,BP,HR had no significant change;there were no hypoxia,reflux and aspiration occurred during induction and intubation,PET-CO2 increased in T2 and returned to normal in T3. Conclusion Rapid sequence intubation of general anesthesia induced by quick acting medicine should apply in non-difficult airway,no severe acute heart and lung disease patients.Application of preoxygenation without positive pressure ventilation is safe and feasible to use in patients with full stomach undergoing emergency operation.