硫酸镁辅助纤维支气管镜引导鼻气管插管：一项双盲随机研究。

Facilitation of fiberoptic nasotracheal intubation with magnesium sulfate: A double-blind randomized study.

作者信息

Elgebaly Ahmed Said, Eldabaa Ahmed Ali

机构信息

Department of Anesthesia and PSICUD, Faculty of Medicine, Tanta University, Egypt.

出版信息

Anesth Essays Res. 2014 Sep-Dec;8(3):291-5. doi: 10.4103/0259-1162.143111.

DOI:10.4103/0259-1162.143111

PMID:25886323

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4258977/

Abstract

BACKGROUND

A double-blinded, prospective, and randomized study was designed to determine the efficacy and tolerability of intravenous (IV) magnesium sulfate (MgSO4) to facilitate fiberoptic bronchoscopic (FOB) nasotracheal intubations.

PATIENTS AND METHODS

A total of 120 patients scheduled to undergo elective awake fiberoptic nasotracheal intubation, while they were anesthetized for elective surgery were randomly allocated to one of three groups: The control Group S (n = 40) received 100 ml (50 ml 0.9% saline + 50 ml paracetamol) was infused in 10 min and direct IV 5 ml 0.9% normal saline, Group MD (n = 40): Received midazolam IV in a dose of 0.07 mg/kg in 5 ml 0.9% normal saline and 100 ml 0.9% was infused in 10 min and Group MS (n = 40): IV 45 mg/kg MgSO4 10 min in 100 ml of 0.9% normal saline through 10 min and direct IV 5 ml 0.9% normal saline.

RESULTS

Time required for nasotracheal intubation was significantly less in group Groups MD and MS, as compared with the control group, but not significant between the two groups. (Group MD: 9.05 + 1.95 min, Group MS 3.75 + 0.75 min and Group S 16.85 + 1.7 min). However, the number of fiberoptic intubation was significantly more in the MD and MS groups, as compared with the control group. Easy intubation (control group: 0, Group MD: 25 and Group MS: 35), moderate difficulty (control group: 5, Group MD: 12 and Group MS: 4) and difficult (control group: 35, Group MD: 3 and Group MS: 1). Procedure adverse events were significantly lower in Group MS. None of the patients in Group MS had procedure hypoxia, but it occurred in 10 patients of Group MD and 20 patients in Group S. Six patients in Group S and two in Group MD had procedure apnea whereas, none of the patients in the MS group experienced this. After medication and just before intubation heart rate and mean arterial pressure were significantly less in Groups MD and MS, as compared to the control group (Group MD: 77 + 7.7 beat/min, Group MS: 70 + 5.6 beat/min and Group S: 80 + 7.8 beat/min) (Group MD: 90 + 8.5 mmHg, Group MS: 80 + 8.1 mmHg and Group S: 105 + 10.5 mmHg). This difference however, significant between Group MD and Group MS.

CONCLUSION

Intravenous MgSO4 improved awaken FOB intubation without adverse hemodynamic or respiratory effects.

摘要

背景

设计了一项双盲、前瞻性随机研究，以确定静脉注射硫酸镁（MgSO4）促进纤维支气管镜（FOB）经鼻气管插管的有效性和耐受性。

患者与方法

总共120例计划接受择期清醒纤维支气管镜经鼻气管插管的患者，在接受择期手术麻醉时被随机分为三组：对照组S（n = 40），在10分钟内输注100 ml（50 ml 0.9%生理盐水+50 ml对乙酰氨基酚），并直接静脉注射5 ml 0.9%生理盐水；MD组（n = 40）：静脉注射咪达唑仑，剂量为0.07 mg/kg，溶于5 ml 0.9%生理盐水中，10分钟内输注100 ml 0.9%生理盐水；MS组（n = 40）：在10分钟内通过100 ml 0.9%生理盐水中静脉注射45 mg/kg MgSO4，然后直接静脉注射5 ml 0.9%生理盐水。

结果

与对照组相比，MD组和MS组经鼻气管插管所需时间显著缩短，但两组之间无显著差异。（MD组：9.05±1.95分钟，MS组：3.75±0.75分钟，S组：16.85±1.7分钟）。然而，与对照组相比，MD组和MS组纤维支气管镜插管次数显著更多。插管容易程度（对照组：0例，MD组：25例，MS组：35例），中度困难（对照组：5例，MD组：12例，MS组：4例）和困难（对照组：35例，MD组：3例，MS组：1例）。MS组的操作不良事件显著更低。MS组没有患者出现操作期间低氧血症，但MD组有10例患者和S组有20例患者出现。S组有6例患者和MD组有2例患者出现操作期间呼吸暂停，而MS组没有患者出现这种情况。用药后且插管前，MD组和MS组的心率和平均动脉压与对照组相比显著更低（MD组：77±7.7次/分钟，MS组：70±5.6次/分钟，S组：80±7.8次/分钟）（MD组：90±8.5 mmHg，MS组：80±8.1 mmHg，S组：105±10.5 mmHg）。然而，MD组和MS组之间的这种差异显著。