右美托咪定在阻塞性睡眠暂停低通气综合征患者经鼻腔气管插管中的作用  

Effect of dexmedotomidine infusion in obstructive sleep apnea hypopnea syndrome patients undergoing nasal intubation

作　　者：薛雷 袁莉[1] 王世端[1] 刘陕岭[1] 单子宝[3] 

机构地区：[1]山东省青岛大学医学院附属医院麻醉科,266003 [2]江苏省淮安市第一人民医院分院麻醉科 [3]日照市中医医院麻醉科

出　　处：《中华临床医师杂志（电子版）》2012年第21期6775-6779,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的右美托咪定(dexmedotomidine,DEX)有镇静、镇痛、健忘作用。因其呼吸抑制轻,对阻塞性睡眠暂停低通气综合征(OSAHS)患者经鼻腔气管内插管有一定优点。方法 70例ASAⅡ～Ⅲ级男性OSAHS患者,根据是否应用DEX随机分为DEX组(D组,36例,麻醉诱导前应用DEX 0.6μg/kg稀释至10 ml,10 min泵完)和对照组(C组,34例,相同时间内泵入等量生理盐水)。两组均充分表面麻醉,间断静脉注射盐酸哌替啶50 mg和氟哌利多1 mg混合液,保留自主呼吸,当患者呈现嗜睡、但对呼叫或拍打有反应且合作时,应用纤维支气管镜引导经鼻腔气管内插入内径7 mm的气管导管。分别记录基础值(T0)、泵注药物后(T1)、气管插管后1 min(T2)、气管插管后3 min(T3)时的心率(HR)、收缩压(SP)、脉搏氧饱和度(SpO2),计算心率收缩压乘积(RPP)值。插管后均机械控制呼吸。结果 70例患者进入研究,术前两组一般资料无统计学差异(P>0.05),所有患者均顺利完成经鼻气管内插管。(1)HR变化:D组应用DEX后HR下降,与T0比较,T1、T3时点HR降低有统计学意义(P<0.01)。C组T2时点HR显著高于T0(P<0.01)。组间比较,除T0外,D组其他各时点HR下降均较C组明显,差异有统计学意义(P<0.05或P<0.01)。(2)SP变化:D组插管过程中SP变化幅度显著小于C组。D组各时点与T0相比,SP变化无统计学意义(P>0.05);而C组T2时点SP显著高于T0(P<0.01)。组间比较C组在T2、T3时点血压上升显著高于D组相同时点(P<0.01)。(3)RPP的变化:D组T1、T3时点RPP显著低于T0(P<0.01),而T2时点RPP高于T0(P<0.05);C组T2时点RPP显著高于T0(P<0.01)。组间比较,D组T2、T3时点RPP值均明显低于C组相同时点的RPP值(P<0.01)。(4)SpO2变化:两组间各时点SpO2比较无统计学差异。结论麻醉诱导前泵注DEX能有效降低OSAHS经鼻腔气管内插管引起的心血管反应。Objective Dexmedotomidine is characterized with effects of sedation,analgesia,amnesia and lack of respiratory depression.So it should be suitable for obstructive sleep apnea hypopnea syndrome(OSAHS)patients undergoing nasal intubation.Methods Seventy ASA physical statusⅡor Ⅲ OSAHS male patients with anticipant difficult airways who were undergoing elective surgery were enrolled and randomly allocated into two groups;the Dex group(group D,n=36)that received dexmedetomidine 0.6 μg/kg infusion for 10 minutes and the Control group(group C,n=34)that received normal saline infusion for 10 minutes.Anesthesia was induced with sufficient superficial anesthesia and pethidine 50 mg and dropreridol 1 mg injected through vein in both groups.During the intubation,all patients maintained a spontaneous respiratory pattern.An ID=7 mm tracheal tube was passed nasally over the fiberscope and its position checked using the fiberscope.Fibreoptic intubation was started when a dexmedetomidine infusion or normal saline infusion provided a sedation in which patients appear to be sleepy but,if stimulated(shout or tap),were easily roused,cooperative,and communicative.Systolic blood pressure(SP),heart rate(HR),heart rate and systolic blood pressure product(RPP),pulse oxygen saturation(SpO2)and adverse effects were recorded at baseline(T0),the time after infusion DEX or saline infusion(T1),1 min after tracheal intubation(T2),and 3 min after tracheal intubation(T3).The patients were mechanically ventilated after nasal intubation.Results A total of 70 patients were enrolled into the study.There were no differences between the baseline data of the two groups(P>0.05).All patients underwent successful nasal fibreoptic intubation.(1)Changes of HR.In group D,the HR was significantly decreased at T1,T3 compared with T0(P<0.01).HR was significantly increased at T2 compared with T0 in group C(P<0.01).HR were much lower in any-point-in-time of group D than those of in group C except at baseline(T0)(P<0.01).(2)Changes of SP.SP in group D during tra

关 键 词：插管法 气管内 睡眠呼吸暂停 阻塞性 右美托咪定 

分 类 号：R766[医药卫生—耳鼻咽喉科]