文章摘要
1倍ED95顺式阿曲库铵辅助下不同剂量丙泊酚对神经监护气管插管条件的影响
Effects of different dosage of propofol assisted with 1 × ED95 cisatracurium on intubation condition of electromyographic endotracheal tube
  
DOI：10.12089/jca.2020.12.005
中文关键词: 神经监护气管插管  甲状腺手术  喉返神经  丙泊酚  顺式阿曲库铵
英文关键词: Electromyographic endotracheal tube  Thyroid surgery  Recurrent laryngeal nerve  Propofol  Cisatracurium
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作者单位E-mail
邹旗 210029,南京市,江苏省人民医院,南京医科大学第一附属医院麻醉与围术期医学科  
徐慧 210029,南京市,江苏省人民医院,南京医科大学第一附属医院麻醉与围术期医学科  
周学龙 210029,南京市,江苏省人民医院,南京医科大学第一附属医院麻醉与围术期医学科  
桂波 210029,南京市,江苏省人民医院,南京医科大学第一附属医院麻醉与围术期医学科 guibosy@163.com 
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中文摘要:
      
目的 比较在1倍ED95顺式阿曲库铵辅助下不同剂量丙泊酚对神经监护气管插管条件的影响。
方法 择期行术中喉返神经监测下甲状腺癌根治术女性患者75例，年龄18～55岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：P1.5组、P2.0组和P2.5组，每组25例，麻醉诱导时分别单次缓慢静注丙泊酚1.5、2.0、2.5 mg/kg。在1倍ED95顺式阿曲库铵辅助下行静脉麻醉诱导，在可视喉镜辅助下插入神经监护气管导管，评估插管条件。记录入室10 min后、插管前、气管导管套囊充气后30 s、2 min和5 min的SBP、DBP和HR，以及诱导期升压药物使用情况。
结果 所有患者均一次性插管成功，并顺利完成术中喉返神经监测。与P1.5组比较，P2.0组与P2.5组插管条件评级4级患者比例明显升高（P<0.05），P2.5组气管导管套囊充气后30 s的SBP、DBP明显降低（P<0.05），P2.5组气管插管前使用升压药物患者比例明显升高（P<0.05）。
结论 在1倍ED95顺式阿曲库铵辅助下行静脉麻醉诱导时，单次静注丙泊酚2.5 mg/kg可提供较好的神经监护气管导管插管条件，不影响术中喉返神经监测，但需密切防范气管插管前低血压。
英文摘要:
      
Objective To compare the effects of different dosage of propofol assisted with cisatracurium 0.05 mg/kg (1 × ED95) on intubation condition of electromyographic (EMG) endotracheal tube.
Methods Seventy-five patients, aged 18-55 years, BMI 18-30 kg/m2, ASA physical status Ⅰ-Ⅱ, were scheduled for elective radical thyroidectomy for thyroid cancer under intraoperative monitoring of recurrent laryngeal nerve. The patients were randomly divided into three groups: group P1.5, group P2.0, and group P2.5, 25 patients in each group. The patients received a single intravenous dose of propofol 1.5 mg/kg, 2.0 mg/kg, and 2.5 mg/kg, respectively. Routine intravenous anesthesia induction was conducted using cisatracurium 0.05 mg/kg. The EMG endotracheal intubation (ID 6.0) was then preformed under the guidance of a video laryngoscope. Intubation conditions of the patients in the three groups were assessed. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) at the time points of baseline, just before intubation, as well as 30 s, 2 min, and 5 min after cuff inflation were recorded. Incidence of vasopressor usage in the three groups were also recorded.
Results All EMG endotracheal tubes were intubated successfully at the first attempt. Meanwhile, different dosages of propofol did not have significant effect on intraoperative monitoring of recurrent laryngeal nerve. Compared with group P1.5, the proportion of patients with grade 4 intubation condition increased in group P2.0 and group P2.5 (P < 0.05), SBP and DBP of the patients in group P2.5 30 s after the endotracheal cuff inflation decreased (P < 0.05), and the proportion of patients receiving vasopressors ahead of intubation was higher in group P2.5 (P < 0.05).
Conclusion During anesthesia induction, a single dose of propofol 2.5 mg/kg, assisted with 1 × ED95 cisatracurium, may provide a high quality of the EMG endotracheal intubation without the negative effect on the intraoperative monitoring of recurrent laryngeal nerve. Meanwhile, hypotension should be avoided before intubation.
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