不同靶控浓度舒芬太尼用于阻塞性睡眠呼吸暂停患者清醒插管的比较

摘要

Objective To compare the effects of different concentrations of sufentanil TCT on stress response and respiratory depression for awake intubation in OSA patients. Methods Sixty OSA patients undergoing selective surgery under general anesthesia were randomly divided into three groups according to TCI concentration of sufentanil. The effect compartment TCI concentrations of group I , II < ID were 0.2 ng/ml, 0.3 ng/ml, 0.4 ng/ml respectively. The values of MAP, HR, SpO2 were recorded and plasma concentration of epinephrine ( NE) and epinephrine ( E) were evaluated before anesthesia (T1), immediately after tracheal tube passing through the nose post-hole (T2) and immediately after tracheal tube passing through the glottis (T3). Results In group I , MAP at T3 and HR at T2, T3 were significantly higher than those at T1 (P<0. 05). SpO2 at T2 and T3 was significantly lower than that at T1 in group Ⅲ(P<0. 05). The plasma NE concentration at all time points showed no statistically significant differences. In group I , the plasma concentration of E increased significantly at T3 (P<0. 05). Conclusion TCI concentration 0. 3 ng/ml of sufentanil can effectively inhibit the stress response to intubation with little respiratory depression and can be widely used for awake intubation in OSA patients.%目的 研究不同靶控浓度舒芬太尼用于阻塞性睡眠呼吸暂停(OSA)患者清醒插管时对应激反应及呼吸抑制的影响.方法 OSA全麻手术患者60例,按舒芬太尼靶控浓度不同随机均分为0.2 ng/ml组(Ⅰ组)、0.3 ng/ml组(Ⅱ组)、0.4 ng/ml组(Ⅲ组).记录患者入手术室时(T1)、气管导管过鼻后孔后即刻(T2)、气管导管过声门后即刻(T3)时MAP、HR、SpO2,及各时点血浆去甲肾上腺素(NE)和肾上腺素(E)浓度.结果 与T1时比较,T3时Ⅰ组MAP明显升高(P＜0.05),Ⅱ、Ⅲ组无显著变化；T2、T3时Ⅰ组HR明显增快(P＜0.05),Ⅱ、Ⅲ组无显著变化；T2、T3时Ⅲ组SpO2明显降低(P＜0.05),Ⅰ、Ⅱ组无显著变化.T1～T3时三组NE无明显变化.T3时Ⅰ组E明显升高(P＜0.05),Ⅱ、Ⅲ组无明显变化.结论 0.3 ng/ml靶控浓度舒芬太尼能有效抑制插管时的应激反应,对呼吸抑制较轻,适合用于OSA患者清醒插管.