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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(obstructive sleep apnea syndrome,OSAS)患者术中应用效果. 方法 选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期行悬雍垂腭咽成形术的OSAS患者60例,依据数字表法随机分为A、B两组(每组30例).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.观察记录麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后3 min (T3)的平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)和脉搏血氧饱和度(pulse oxygensaturation,SpO2).同时记录声门暴露程度(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副作用. 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时又都有不同程度的升高(P＜0.05).A组声门暴露情况优于B组,首次插管成功率较高为96.7％,喉外部压迫操作及Magil插管钳辅助发生率少,约为16.7％和10.0％,且术中A组瑞芬太尼的用量明显减少(P＜0.05).与B组比较,术毕A组麻醉恢复时间、拔管时间[(11±3) min]缩短,而躁动评分及视觉模拟评分(visual analoguescales,VAS)较低,为(0.62±0.27)分和(2.1±0.4)分(P＜0.05). 结论 健忘镇痛慢诱导联合Glidescope视频喉镜插管更加简便安全,麻醉诱导期和术中血流动力学更加平稳.患者术后苏醒迅速,镇痛满意.

Objective To observe the effect of forgetfulness analgesia slow induction combined Glidescope video laryngoscope in patients with obstructive sleep apnea syndrome (OSAS).Methods Sixty ASA Ⅰ-Ⅱ patients undergoing uvulopalatopharyngoplasty surgery (UPPP) were randomly assigned into group A and group B (n=30).Patients in group A were nasotracheal intubation with Glidescope video laryngoscope after forgetfulness analgesia slow induction and patients in group B were nasotracheal intubation with Macintosh direct laryngoscope after fast induction.The mean artery pressure(MAP),heart rate(HR) and pulse oxygen saturation (SpO2) were recorded before anesthesia induction (T0),before intubation (T1),at the time of intubation (T2) and 3 min 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.The anesthesia recovery and untoward effect of the two groups were compared.Results Compared with T0,vital signs in group A were stable during anesthesia induction and intubation,but the MAP and HR in group B were decreased in T1,increased in T2 and T3 (P＜0.05).The glottis exposure in group A was better than that in group B.Success rate of intubation in group A was higher for the first time (96.7％).The oppression of laryngeal external (16.7％),auxiliary of Magil intubating forceps (10.0％) and remifentanil dose [(0.72±0.16) mg] were less than group B (P＜0.05).Compare with group B,the anesthesia recovery time and extubation time of group A were shorten [(11±3) min],the Sedation-Agitation Scale (0.62±0.27) and visual analogue scales (VAS) score (2.1±0.4) lower (P＜0.05).Conclusions Forgetfulness analgesia slow induction combined Glidescope video laryngoscope 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.