国际麻醉学与复苏杂志   2015, Issue (12): 12-12
    
健忘镇痛慢诱导联合视频喉镜在阻塞性睡眠呼吸暂停综合征术中的应用
陈莉1()
1.大连市友谊医院
Application of forgetfulness analgesia slow induction combined Glidescope video laryngoscope in patients undergoing obstructive sleep apnea syndrome surgery
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摘要:

目的 探讨健忘镇痛慢诱导联合Glidescope视频喉镜在阻塞性睡眠呼吸暂停综合征(OSAS)患者术中临床应用效果。方法 选择ASAⅠ~Ⅱ级择期行悬雍垂腭咽成形术的 OSAS患者60例,年龄27~48岁,体重78~106kg,随机分为A、B两组。A组为健忘镇痛慢诱导后应用Glidescope视频喉镜行经鼻气管插管,B组为常规静脉快速诱导后应用Macintosh普通喉镜行经鼻气管插管。两组患者术中均应用丙泊酚复合瑞芬太尼在Narcotrend的监测下维持相对稳定的麻醉深度,应用罗库溴铵维持肌松。观察记录麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后3min(T3)的MAP、HR和SPO2 。同时记录声门暴露分级(Cormark-Lehane分级),喉外部压迫操作、Magil插管钳辅助、喉镜上沾血的发生率以及两组患者的插管情况,比较两组患者麻醉苏醒情况以及不良反应。结果 与T0比较,A组在诱导、插管过程中生命体征平稳,B组在T1时,MAP和HR均有下降,而在T2 、T3时,MAP和HR又都有不同程度的升高,差异有统计学意义(P<0.05)。A组声门暴露情况优于B组,插管时间更短,首次插管成功率较高,喉外部压迫操作及Magil插管钳辅助发生率少,且术中A组应用镇痛药剂量明显减少,差异有统计学意义(P<0.05)。术毕B组麻醉恢复时间、拔管时间较A组延长,而A组的躁动评分和VAS评分明显低于B组,差异有统计学意义(P<0.05)。结论 健忘镇痛慢诱导联合Glidescope视频喉镜用于阻塞性睡眠呼吸暂停综合征手术患者麻醉不仅插管安全迅速,降低了低氧血症的发生率,还使麻醉诱导期和术中血流动力学更加平稳。术后苏醒迅速完全,镇痛满意,降低了拔管风险。因此其可良好应用于此类患者手术麻醉,有临床推广价值。

关键词: 健忘镇痛慢诱导;Glidescope视频喉镜;经鼻气管插管; 阻塞性睡眠呼吸暂停综合征
Abstract:

【Objective】To observe the effects of forgetfulness analgesia slow induction combined Glidescope video laryngoscope in patients with obstructive sleep apnea syndrome(OSAS). 【Methods】Sixty ASAⅠ~Ⅱ patients aging 27~48 years and weighing 78~106kg undergoing uvulopalatopharyngoplasty surgery (UPPP)were randomly assigned for A,B 2 groups. Group A were nasotracheal intubation with Glidescope video laryngoscope after forgetfulness analgesia slow induction and Group B were nasotracheal intubation with Macintosh direct laryngoscope after fast induction. In all subjects, the relatively stable depth of anesthesia was maintained by propofol and remifentanil, the muscular relaxant was Rocuronium. The MAP, HR and SPO2 were recorded before anesthesia induction(T0), intubation(T1), at the time of intubation(T2) and 3min after intubation(T3). Cormark-Lehane grade, the oppression of laryngeal external, the auxiliary of Magil intubating forceps, the incidence of blood on the laryngoscope and the conditions of intubation were all recorded. Compare the anesthesia recovery and untoward effect of the two groups. 【Results】Compare with T0, group A had stable vital signs in the process of anesthesia induction and intubation, but the MAP and HR of group B were decreased in T1 and increased to varying degrees in T2 、T3(P<0.05). The glottis exposure of group A is better than that of group B, group A had shorter intubation time, higher success rate of intubation for the first time. The oppression of laryngeal external, auxiliary of Magil intubating forceps and analgesic dose were less than group B(P<0.05). Compare with group A, the anesthesia recovery time and extubation time of group B were extended, but the Sedation-Agitation Scale and VAS score were higher. 【Conclusion】 Forgetfulness analgesia slow induction combined Glidescope video laryngoscope in OSAS patients undergoing UPPP surgery, not only make intubation method simple and rapid, but also make the hemodynamic of anesthetic induction period and intraoperative more smoothly. After operating, quickly complete awakening, satisfactory analgesia and fewer postoperative agitation all make it well be used in anesthesia in patients with obstructive sleep apnea syndrome.

Key words: Forgetfulness analgesia slow induction; Glidescope video laryngoscope; Nasotracheal intubation; obstructive sleep apnea syndrome(OSAS)