目的 比较不同剂量组合瑞芬太尼-利多卡因-丙泊酚在无肌松药情况下行气管插管时对插管状态和心血管反应的影响.方法 80例拟行择期手术患者随机均分为四组:瑞芬太尼3 μg/kg、丙泊酚2 mg/kg(组Ⅰ),瑞芬太尼3μg/kg、利多卡因1.5 mg/kg、丙泊酚2 mg/kg(组Ⅱ),瑞芬太尼4 μg/kg、丙泊酚2 mg/kg(组Ⅲ),瑞芬太尼3 μg/kg、丙泊酚3 mg/kg(组Ⅳ).分别记录气管导管气囊充气前后的插管状态.记录麻醉诱导前、诱导后、气管插管后即刻、3、5分钟的平均动脉压(MAP)和心率(HR)值.结果 气管导管气囊克气前后,组Ⅱ、Ⅲ和Ⅳ比组Ⅰ获得满意插管率更高(P＜0.05),Ⅱ、Ⅲ和Ⅳ组间无统计学差异.所有患者MAP和HR在麻醉诱导后与麻醉诱导前相比均有显著下降(P＜0.05).结论 联合使用瑞芬太尼3μg/kg-利多卡因1.5 mg/kg-丙泊酚2mg/kg可能是用于无肌松药气管插管的较优组合.%Objective The study was designed to compare the intubating conditions and haemodynamic responses without muscle relaxants following different dosage regimens of remifentanil, lidocaine and propofol. Methods 80 healthy patients were assigned to four groups, including Group Ⅰ treated with remifentanil 3μg/kg and propofol 2 mg/kg, Group Ⅱ treated with remifentanil 3μg/kg, lidocaine 1.5 mg/kg and propofol 2 mg/kg, Group Ⅲ treated with remifentanil 4μg/kg and propofol 2 mg/kg, and Group Ⅳ treated with remifentanil 3μg/kg and propofol 3 mg/kg.Groups Ⅰ , Ⅲ, and Ⅳ were given same volume of 0. 9％ saline instead of lidocaine in Group Ⅱ. The intubating conditions were assessed as excellent, good or poor. Mean arterial pressure ( MAP) and heart rate ( HR) were recorded before induction, postinduction, immediately after intubation, and three and five minutes after intubation. Results Satisfactory intubation conditions in Group Ⅰ were significantly better than that in Group Ⅱ, Ⅲ, and Ⅳ ( P ＜ 0.05 ). Significant reductions in MAP and HR after administration were observed in each group ( P ＜ 0.05 ). Conclusion The coadministration of remifentanil 3μg/kg, lidocaine 1.5 mg/kg, and propofol 2 mg/kg may reliably provide adequate conditions for tracheal intubation with less hemodynamic suppression in healthy patients without muscle relaxants.
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