复合肌松剂下喉罩控制通气在无痛纤维支气管镜检查中的应用*

Application of controlled ventilation with laryngeal mask airway combined compound muscle relaxant in fiberoptic bronchoscopy*

摘要:

摘要：目的   观察复合肌松剂下喉罩控制通气应用于无痛纤维支气管镜检查的有效性和安全性。方法   选择美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级，年龄41～65岁，拟行无 痛纤维支气管镜检查的患者60例，随机分为观察组（n =30）和对照组（n =30）。观察组采用小剂量罗库溴铵复合琥珀胆碱联合喉罩行控制通气，对照组采用琥珀胆碱联合喉罩行控制通气。观察两组患者检查中生命体征变化、镜检条件、肌束震颤及检查后肌肉疼痛发生情况，记录两组患者自主呼吸恢复时间、潮气量恢复时间、呼之睁眼时间、喉罩拔除时间及麻醉后监测治疗室停留时间。结果   两组患者检查中生命体征变化和镜检条件差异无统计学意义（P>0.05），观察组肌束震颤和检查后肌肉疼痛发生率及评分明显低于对照组（P<0.05），观察组自主呼吸恢复时间明显长于对照组（P< 0.05），两组患者潮气量恢复时间、呼之睁眼时间、喉罩拔出时间及麻醉后监测治疗室停留时间差异无统计学意义（P>0.05）。结论  小剂量罗库溴铵复合琥珀胆碱联合喉罩控制通气可为无痛纤维支气管镜检查提供充分氧合水平和良好镜检条件，具有可靠的临床有效性和安全性。

Abstract:

  Abstract: Objective To evaluate the efficacy and safety of controlled ventilation with laryngeal mask airway combined compound muscle relaxant in fiberoptic bronchoscopy. Methods A total of sixty ASA Ⅰ～Ⅱ grade patients with an aged range 41 ～ 65 years, who would undergo fiberoptic bronchoscopy, were randomly divided into observation group (Group O, n = 30) and control group (Group C, n = 30). Group C received placebo and Group O received Rocuronium 0.05 mg/kg, one minute prior to induction with Propofol 1.00～2.00 mg/kg, Remifentanil 1～2 μg/kg, and Suxamethonium 1.00 mg/kg. The mean arterial pressure (MAP), heart rate (HR) and Pulse Oxygen Saturation (SpO2) during endoscope inspection were evaluated. The operating condition in the two groups was recorded. Fasciculation was assessed immediately after the induction of anesthesia while myalgia was assessed 72 hours after bronchoscopy. The time of spontaneous breathing recovery, normal tidal volume, eye opening, extubation and postanesthesia intensive care unit (PACU) stay in two groups were recorded. Results There was no significant difference between two groups in MAP, HR, SpO2 and operating condition (P > 0.05). The incidence and score of fasciculation and myalgia in Group O were significantly less than those in Group C (P < 0.05). The patients in Group O took longer to recover spontaneous breathing than those in Group C (P < 0.05). No significant difference between two groups was shown in tidal volume recovery, eye opening time, extubation time and PACU stay (P > 0.05). Conclusion It is concluded that controlled ventilation with laryngeal mask airway combined compound muscle relaxant is safe and effective alternative to fiberoptic bronchoscopy.