喉罩-瑞芬太尼复合异丙酚在无痛苦纤支镜检中的应用

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。

Application of laryngeal mask combined with remifentanil-propofol anesthesia in painless flberoptic bronchoscopy check-up

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.