七氟醚在颈椎损伤患者行纤支镜引导插管中应用

摘要

[Objective] To evaluate the Sevoflurane combined with fentanyl for Fiberoptic intubation in patients with cervical spine injury through the nasal cavity. [ Methods ] Twenty Patients ASA II - HI (aged 20-65 y) with cervical spine injury with neurological impairment scare C-E of ASIA undergoing elective surgery were enrolled, 0.05 mg of atropine as premedicant, 2% lidocaine combined ephedrine was used to treat the mucous membrane of the nasal cavity, anesthesia induction with the 4%~6% endtidal sevoflurane concentration maintained for lOmin and 2u,g/kg fentanyl were administered before 5 min when Fiberoptic intubation was performed. Cortisol and cate- cholamine of plasma, invasive blood pressure, blood gas analysis (Pha, PaCO2 and PaO2), cough, struggle, laryn-gospasm and hypoxemia were recored before and immediately after, 5min of Fiberoptic intubation. [Results] All patients were performed by Fiberoptic intubation successfully, the catecholamine of plasma was (109.6±45.89) ng/L, (112.81±45.59) ng/L and (118.73±49.37) ng/L, respectively (P>0.05). [Conclusion] Sevoflurane combined with fentanyl for Fiberoptic intubation in patients with cervical spine injury was feasibility in clinical work.%目的 探讨七氟醚复合芬太尼麻醉诱导下纤维支镜管镜(纤支镜)引导经鼻气管插管在颈椎损伤患者中的可行性.方法 选择颈椎损伤但脊髓损伤分级(ASIA)在C-E级的患者20例,年龄在20～65岁,ASAⅡ～Ⅲ级.所有患者均在麻醉前使用阿托品0.01 mg/kg肌肉注射.选择较通畅的一侧鼻腔的鼻咽部黏膜用2％利多卡因和麻黄碱混合液行表面麻醉同时收缩黏膜血管,麻醉诱导:静脉注射芬太尼2μg/kg,吸入七氟醚浓度为4％ ～6％.10 min后在纤支镜引导下经鼻气管插管,记录插管前、插管后即刻、插管后5min血浆儿茶酚胺浓度、血流动力学变化和血气分析,并同时观察可能出现的不良气道事件(SPO2＜90％和喉痉挛)、气管插管时肢体和呛咳反应情况.结果 所有患者均顺利完成气管插管,在插管前后血浆儿茶酚胺浓度变化差异无显著性,未见低氧血症和喉痉挛等不良气道事件发生.结论 七氟醚联合芬太尼麻醉纤支镜引导经鼻气管插管在颈椎损伤患者中应用的方法可行,有一定的临床应用价值.