肌松監測指導老年患者氣管插管的臨床研究

張麗峰 史東平 鮑 楊 封衛征

[摘要]目的 通過肌松監測指導老年患者氣管插管,減少或避免插管時嗆咳、屏氣、血壓升高、心率增快等不良反應。方法 選擇老年患者80例,年齡65-80歲,ASA分級為Ⅰ-Ⅱ級,實施全身麻醉。 隨機分為傳統氣管插管組(A組)和肌松監測下氣管插管組(B組)。觀察插管時病人的反應(嗆咳、肢體活動、聲帶活動、咬肌緊張);記錄各時間點(基礎值、插管前、插管后1分鐘、插管后3分鐘)的平均動脈壓(MAP)、心率(HR)。 結果 傳統插管組插管時嗆咳等反應發生20/40例, 肌松監測組4/40例;傳統插管組插管后1分鐘、3分鐘的MAP、HR較插管前明顯升高(P<0.05),肌松監測下氣管插管組無明顯變化。結論 老年患者在肌松監測下氣管插管時,嗆咳屏氣等反應明顯減少,插管前后血流動力學穩定,可見肌松監測下氣管插管適合于老年患者。

[關鍵詞] 肌松監測; 氣管插管;嗆咳反應;血流動力學

[中圖分類號] R61 [文獻標識碼] A [文章編號] 1004-8650(2009)05-058-03

[Abstract] Objective Of monitoring muscle relaxation through the guidance of elderly patients with tracheal intubation, in order to reduce the intubation response, such as cough and reduce the cardiovascular side effects. Methods 80 cases of 65-80 year-old undergoing general anesthesia in elderly patients, ASA grade Ⅰ-Ⅱ grade, no dysfunction of neuromuscular transmission history. Tracheal intubation were randomly divided into the traditional group (A group) and monitoring of muscle relaxant intubation group (B group) (all 40 cases, A group 2min after tracheal intubation-induced, B group TOF value of endotracheal intubation 0:00) . Induced Results midazolam 0.05mg/kg, fentanyl 3ug/kg, propofol 1.5mg/kg, A group of direct intravenous injection of cis-atracurium 0.15mg/kg (3 × ED95), after administration 2min tracheal intubation; B group monitors the use of muscle relaxant, the patient awareness of the disappearance of muscle r elaxant after calibration, when the values stabilized at 100 percent of intravenous cis-atracurium, the same amount with the A group, when TOF value of 0:00 endotracheal intubation. Observation of the patient's response to intubation (cough, physical activity, vocal activity, masseter muscle tension); recorded at different time points (baseline, before intubation, after intubation 1min, after intubation 3min) of mean arterial pressure (MAP ), heart rate (HR). Results Traditional intubation intubation group, such as choking up to 50% of severe reactions, and muscle relaxation monitoring group representing a slight 10%; A group after intubation 1min, 3min of MAP, HR significantly higher than pre-intubation (P < 0.05), B group had no significant changes in hemodynamic stability. Conclusions Elderly patients with monitoring of musclerelaxation through the guidance of tracheal intubation, compared with conventional intubation, such as cough response was decreased significantly after intubation to reduce cardiovascular response, we can see under the monitoring of muscle relaxation for tracheal intubation in elderly patients.

[Key words] Monitoring of muscle relaxation; endotracheal intubation; choking reaction; flow dynamics

隨著社會人口的老齡化,老年患者手術越來越多,且多合并有夾雜癥,需在全身麻醉下實施手術。全身麻醉氣管插管時常常發生嗆咳、屏氣、聲帶活動、咬肌緊張等反應,引起血壓升高,心率增快、心律失常等,導致老年患者心血管意外的發生。本研究旨在肌松監測下指導氣管插管,選擇最佳插管時機,減少插管時引起的不良反應,降低并發癥和由此引起醫療費用,提高老年患者術后恢復質量。

1資料與方法

1.1一般資料

選擇80例ASAⅠ-Ⅱ級的擇期老年全麻患者,術前心、肺、肝、腎功能正常,無神經肌肉疾病,體重指數(BMI)平均為25,年齡65-80(平均70)歲,隨機分成傳統插管組[A組](即誘導后2分鐘氣管插管)和肌松監測下插管組[B組](即TOF值達0時氣管插管),每組各40例。

1.2麻醉方法

所有患者均無術前用藥,入手術室后開放外周靜脈。……