不同剂量右美托咪定用于清醒经鼻盲探气管插管的效果  

Efficacy of different doses of dexmedetomidine for conscious blind nasotracheal intubation

作　　者：曹丙玉[1] 

机构地区：[1]新泰市人民医院麻醉科,271200

出　　处：《国际医药卫生导报》2011年第2期192-195,共4页International Medicine and Health Guidance News

摘　　要：目的 观察不同剂量右美托咪定用于清醒经鼻肓探气管插管的效果.方法 择期气管插管全麻下行手术病人51例,年龄32～46岁,ASA Ⅰ～Ⅱ级,所有病人均无心、脑血管疾病.随机分为单纯表面麻醉组（S组）、表面麻醉＋右美托咪定0.5 μg/kg组（D1组）和表面麻醉＋右美托咪定1.0 μg/kg组（D2组）,每组17例.三组病人均用1%丁卡因行鼻腔、咽喉,及气管粘膜表面麻醉,D1组和D2组将盐酸右美托咪定注射液（艾贝宁批号10061434国药准字H20090248江苏恒瑞医药股份有限公司）用0.9%的氯化钠溶液稀释至浓度4μg/ml后缓慢静注,输注时间15min.1 min后行经鼻肓探气管捅管.记录入室后麻酢前（T0）、插管前即刻（T1）、气管导管插入鼻腔即刻（T2）、气管导管越过声门插入气管即刻（T3）的MAP、HR、SpO2;记录插管过程中有无恶心、呛咳、躁动等插管反应;术后随访病人对插管过程的知晓情况.结果 与T0比较,S组T2、T3时MAP及HR明显升高,差异具有显著性（P〈0.05）; D1组T1时MAP明显降低,T3时MAP及HR却明显升高,差异均有显著性（P〈0.05）; D2组T1、T2及T3时MAP均明显降低,T1时HR明显降低,差异均有显著性（P〈0.05）.与D1组、D2组比较,S组T1、T2及T3时MAP、HR均明显高于D1组、D2组,而T3时SpO2明显低于D1组、D2组差异均有极显著性（P〈0.01）;与D1组比较,D2组T1、T2及T3时MAP均明显降低,D2组T2、T3时HR明显降低,差异具有显著性（P〈0.05）.与S组比较,D1组呛咳、躁动及插管知晓发生率明显减少,差异有显著性（P〈0.05）; D2组恶心、呛咳、躁动及插管知晓发生率明显减少,差异有极显著性（P〈0.01）;与D1组比较,D2组恶心、呛咳、躁动及插管知晓发生率明显减少,差异有显著性（P〈0.05）.结论 在表面麻醉的基础上,缓慢静注右美托咪定1.0 μg/kg可为施行清醒经鼻盲探气管插管提供良好的条件,是安全、有效的.Objective To investigate the effect of different doses of dexmedetomidine for conscious blind nasotracheal intubation. Methods Fifty-one ASA？～？ patients undergoing general anesthesia for elective surgery were randomly divided into 3 groups.The type of anesthesia for tracheal intubation （n = 17 each ）： group ？ received surface anesthesia only; group ？ and ？ received dexmedetomidine 0.5 or 1.0 礸/kg on top of surface anesthesia. All patients received surface anesthesia of nasal cavity, pharynx and larynx, trachea with 1% tetracaine. In group ？ and group ？ Dexmedetomidine 燞 ydrohloride 營 njection （batch number 10061434, approved number H20090248, produced by Jiangsu HengRui pharmaceutical Co., LTD） was diluted reach to 4 μ g/ml with the 0.9% sodium chloride solution. Then Dexmedetomidine 0.5 or 1.0 礸/kg Ⅳ 15 min. 1 min later conscious blind nasotracheal intubation was operated. MAP, HR and SpO2 were continuously monitored and recorded before anesthesia （T0）, before trachea cannula （T1）, when tracheal tube was inserted into nasal （T2） and advanced through vocal cords into trachea （T3）. Responses like nausea,coughing and restlessness were also recorded. The patient 抯 awareness of the intubation was noted after operation. Results MAP and HR were significantly increased at T2 and T3, compared with them at T0 in group ？（P〈 0.05）. MAP was significantly decreased at T1, compared with it at T0 （P〈 0.05）; while MAP and HR were significantly increased at T3, compared with then at T0 in group Ⅱ （P〈 0.05）.MAP was significantly decreased at T1 、 T2and T3, compared with it at T0 （P〈 0.05）;and HR was significantly decreased at T1,compared with it at T0 （P〈 0.05） in group ？. MAP and HR were significantly increased at T1、 T2 and T3 in group ？, compared with them in group ？ and ？ （P〈 0.01）. SpO2 was significantly decreased at T3in group ？,compared with it in group ？ and ？ （P〈 0.01）. MAP was significantly decreased at

关 键 词：右美托咪定 清醒经鼻盲探气管插管 清醒镇静 

分 类 号：R614[医药卫生—麻醉学]