小剂量舒芬太尼在清醒经鼻盲探气管插管中的应用  

Low dosage sufentanil used in conscious blind nasotracheal intubation

作　　者：李源[1] 徐礼鲜[1] 卢玲玲[1] 张国良[1] 马加海[1] 

机构地区：[1]第四军医大学口腔医学院麻醉科,陕西西安710033

出　　处：《第四军医大学学报》2005年第9期841-843,共3页Journal of the Fourth Military Medical University

摘　　要：目的:探索小剂量舒芬太尼在清醒经鼻盲探气管插管术中静脉镇静、镇痛的可行性.方法:选口腔颌面外科手术患者60例,随机分为3组,每组20例.Ⅰ组为芬太尼咪唑安定组,Ⅱ组为氟哌啶芬太尼组,Ⅲ组为舒芬太尼组.术前肌注阿托品咪唑安定.3组均按常规表面麻醉后开始插管,比较患者静脉注药前(T1)、静脉注药后(T2)及插入管后(T3)的平均动脉血压(MAP)、心率(HR)及脉搏血氧饱和度(SpO2);记录有无插管并发症、镇静程度、患者满意度和遗忘程度.结果:与T1时间比较,Ⅰ,Ⅱ组在T2和T3时间点Ramsayscore有明显上升,Ⅰ组80%,Ⅱ组85%患者Ramsay score达到2～3分;在T2时间点,MAP,HR和SpO2下降(P<0.05);T3时间点MAP,HR和SpO2均有不同程度升高;Ⅲ组患者在T2时间点以后呈轻度镇静,无焦虑、注意力下降状态,Rmasayscore达2～3分者占90%,MAP,SpO2改变不明显,HR与T1时间比较有所下降(P<0.05).3组气管插管操作过程遗忘的发生率及镇静、镇痛的满意度比较无显著差别(P>0.05).结论:小剂量舒芬太尼可适用于清醒盲探气管插管术中患者镇静和镇痛,并在降低心血管副反应方面具有一定的优势.AIM: To investigate sedative and analgesic effect of little dosage sufentanil used in conscious blind nasotracheal intubation. METHODS: Sixty cases of maxillofacial surgery were selected and were randomly divided into 3 groups, with 20 cases in each group. The patients in groupⅠ were given fentanyl and midazolam by vein, the patients in groupⅡ were given fentanyl and droperidol by vein, and the patients in groupⅢ were only given sufentanil by muscular injection. Intramuscular premedication (Atropine-Midazolam) was performed in all the cases. After surface anesthesia, conscious blind nasotracheal intubation was conducted. The changes of MAP, HR, SpO 2, intubational complications, sedation score (Ramsay score), satisfaction and amnesia of patient in the three groups at T1 (before drug administration), T2 (after drug administration) and T3 (after the insertion of tracheal into tracheal) were observed. RESULTS: In groupⅠ and Ⅱ, Compared with those at T1, the Ramsay score increased obviously at T2 and T3, and MAP, HR and SpO 2 descended at T2, while MAP, HR and SpO 2 rose significantly at T3 (P<0.05). In groupⅢ, at T2 and T3, the patients were found in a mild degree of sedation, and no marked changes were observed in MAP and SpO, but HR descended obviously (P<0.05). No significant differences in the satisfaction and amnesia were found between the three groups (P>0.05). CONCLUSION: Low dose sulfentanyl can be applied to the sedation and analgesia in conscious blind nasotracheal intubation, which can lower cardiovascular adverse reactions.

关 键 词：舒芬太尼 清醒经鼻盲探气管插管 清醒镇静 镇痛 

分 类 号：R318[医药卫生—生物医学工程]