本文關(guān)鍵詞： 氣管插管 纖維支氣管鏡 舒芬太尼 七氟烷 丙泊酚　出處：《山西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較利用七氟烷或者丙泊酚同時靶控輸注舒芬太尼進行誘導(dǎo)后,在不給于肌松藥的情況下,同時使用纖維支氣管鏡進行氣管插管,觀察其臨床效果。方法:60個選擇一定日期做手術(shù)的患者,年齡大約在18-65歲之間,體重與身高的平方之比在18.5-24之間,男病人與女病人比例沒有要求,ASAⅠ-Ⅱ級,將病人速記分配到兩個組內(nèi),分別是七氟烷組(S組)或者丙泊酚組(P)組,兩個均即利用計算機控制泵入舒芬太尼,在利用纖維支氣管鏡的幫助下經(jīng)過口腔來實施氣管插管。所有病患在進入手術(shù)室以后,都無一例外的監(jiān)測心電圖,利用袖帶記錄血壓(NBp),心率(HR),脈搏氧飽和度(Sp O2),護士進行輸液,從開始到結(jié)束整個操作流程中輸液的速度保持在4ml/min。給予咪達唑侖2mg,鼻導(dǎo)管(2L/min)吸氧5min,連接肌松監(jiān)測儀。兩個組都選擇利用計算機控制輸入舒芬太尼,并且選擇效應(yīng)室模式,在裝置上按鍵選擇性別,年齡,身高,體重,輸入濃度為0.3ng/ml。丙泊酚也同時選擇利用計算機泵入,選定起始濃度為3.5 ug/ml,開始后,利用面罩讓病人吸氧,若誘導(dǎo)過程中Sp O290%,則先托起下頜,若Sp O2下降不能改善時,則輔助呼吸。七氟烷組選用潮氣量法誘導(dǎo),預(yù)先告知患者氣體為有機溶劑的味道,將蒸發(fā)器和新鮮氣流打為雙8%,面罩緊緊扣住病人的臉面部,讓患者做大口呼吸,直至患者沒有意識,操作者很大聲的叫喚也沒有反應(yīng)后,撥動患者睫毛也沒有反應(yīng)時,將蒸發(fā)器濃度調(diào)減低到4%,新鮮氣流調(diào)到4 L/min,等待患者的下頜比較松,OAA/S≤2時,這個時候開始利用鏡子實施插管。同時助手寫下患者在剛剛進入室后(T0)、誘導(dǎo)前(T1)、誘導(dǎo)后(T2)、插管后即刻(T3)、插管后1min(T4)、插管后2min(T5)的血壓(MAP)、心率(HR)、脈搏氧飽和度(Sp O2);及誘導(dǎo)前(T1),誘導(dǎo)后(T2),及插管后(T3)的TOF值(%);鏡子進入的鏡深度及管子插入的深度,誘導(dǎo)后OAA/S評分;記錄插管及術(shù)后24h時不良反應(yīng)發(fā)生率。結(jié)果:兩組間比較,P組MAP在T2時較S組降低,HR在T2時、T3時、T4時、T5時較S組升高,意識消失與誘導(dǎo)時間較S組長,給麻黃堿例數(shù)較S組多(P0.05);兩組的MAP、HR在其余各時間點差異均無統(tǒng)計學(xué)意義(P0.05),兩組的插管時間,進鏡及插管深度,給阿托品例數(shù),TOF值,誘導(dǎo)后OAA/S評分,副作發(fā)生的情況方面統(tǒng)計學(xué)指標(biāo)沒有比較意義(P0.05)。與T1時比較,P組MAP在T2時、T3時降低,HR在T3時升高;S組MAP在T2時、T3時降低,HR在T2時升高(P0.05),其他各個時間點的不同性比較沒有意義。結(jié)論:七氟烷與丙泊酚伍用舒芬太尼誘導(dǎo)均可安全用于全麻患者無肌松氣管插管,為操作者提供較好的插管條件。
[Abstract]:Objective: To compare the use of seven halothane or propofol and sufentanil TCI were induced by not to muscle relaxant condition, at the same time using fiberoptic bronchoscope intubation, observe its clinical effect. Methods: 60 patients with certain date of surgery, age at about 18-65 years of age, and weight the square of the height ratio between 18.5-24, not the proportion of male patients and female patients, ASA I-II, were assigned to two groups respectively, were seven halothane group (S group) and propofol group (P group), two were namely the use of computer control in the infusion of sufentanil, the use of fiberoptic bronchoscopy to help after oral tracheal intubation. All patients in the operation room after all the ECG monitoring, record blood pressure cuff (NBp), heart rate (HR), pulse oxygen saturation (Sp O2), nurses from the infusion. Start to finish the whole operation process of infusion rate of midazolam administered 2mg in 4ml/min. (2L/min), nasal catheter oxygen 5min, connecting muscle relaxation monitor. The two groups were selected using computer control input and selection effect of sufentanil, room mode, the device select according to gender, age, height, weight. The input concentration of 0.3ng/ml. propofol also choose pump into computer use, selected initial concentration was 3.5 ug/ml, after the start, the use of oxygen masks allows patients during induction of Sp, if O290%, then Sp O2 chin, if the fall does not improve, then breathe. Seven halothane group were induced by the tidal volume, advance inform patients of organic solvent gas smell, and fresh air to the evaporator 8%, fasten the patient's face facial mask, so that patients do not breathe, until the patients consciousness, the operator call loudly 涔熸病鏈夊弽搴斿悗,鎷ㄥ姩鎮(zhèn)ｈ，

本文編號：1510243