摘要目的 评价丙泊酚联合瑞芬太尼靶控输注(TCI)麻醉诱导,用于纤维支气管镜(FOB)气管插管的可行性,并与手控输注(MCI)相比较.方法 2009年12月到2010年1月本院24例预计无困难气道,择期气管插管全身麻醉手术患者,完全随机分为TCI组及MCI组(每组12例).分别以TCI或MCI丙泊酚联合瑞芬太尼诱导下行FOB插管.记录诱导期间血压、心率、脉搏氧饱和度,Narcotrend指数(N1)监测麻醉深度,记录意识消失时间、插管时间、插管评分、用药量及不良反应.结果 TCI组患者意识消失时间、插管时间比MCI组显著缩短[(2.2±0.5)比(5.3±2.3)min,(7.7±3.9)比(12.5±4.5)min,P＜0.01].2组插管评分、丙泊酚及瑞芬太尼用量差异无统计学意义.2组血压、心率诱导后均较诱导前明显下降,插管后MCI组心率明显低于TCI组(P＜0.05).TCI组NI值下降较MCI组快速.2组未见明显不良反应,对插管过程无记忆.结论 丙泊酚联合瑞芬太尼诱导可安全有效用于无全身麻醉诱导禁忌患者FOB气管插管.其中TCI模式较MCI模式,诱导及插管迅速,血流动力学更平稳.

abstractsObjective To evaluate the feasibility of combined Propofol and Remifentanil targetcontrolled infusion (TCI) for anesthesia induction during tracheal intubation under fibreoptic bronchoscope (FOB) , and to compare the outcomes with manually controlled infusion (MCI). Methods Between December 2009 and January 2010, 24 patients registered to our hospital, who were predictedly without difficult airway and scheduled for elective surgery under general anesthesia with tracheal intubation, were randomly divided into two groups: TCI group and MCI group (n=12 each). FOB intubation was completed under TCI or MCI Propofol and Remifentanil induction respectively. Blood pressure(BP), heart rate(HR),SPO2, and Narcotrend index (NI)were used to monitor anesthetic depth during the induction. In addition,time to loss of eonciousness (LOC), intubation time, intubation score, anesthetic dosage and adverse effects were recorded. Results LOC and intubation time of TCI group were significantly shorter than those of MCI group [ (2.2±0.5) vs (5.3±2.3)min and (7.7±3.9) vs (12.5±4.5)min, respectively,P＜0.01 ]. No significant differences in intubation score, Propofol and Remifentanil dosage were found between the two groups. BP and HR decreased significantly after induction in both groups (P＜0.05), with MCI group showing greater decrease in HR after intubation compared to TCI group(P＜0.05). NI of TCI group dropped faster than that of MCI group (P＜0.05) . Neither significant adverse effects nor recall about intubation was noted.Conclusions Propofol and Remifentanil induction can be safe and effective for FOB intubation in the patients without general anesthesia contraindications. Compared with MCI mode, TCI mode can provide faster induction and intubation with more stable haemodynamics.