右美托咪定和咪达唑仑对经鼻插管血流动力学和镇静的影响  

Effect of dexmedetomidine and midazolam on hemodynamics and sedation in patients with nasal intubation

作　　者：徐雪[1] 戚翔[1] 梁治[1] 张晓青[1] 董振明[1] 

机构地区：[1]河北医科大学第二医院麻醉科,石家庄050051

出　　处：《中国医师进修杂志》2012年第6期1-3,共3页Chinese Journal of Postgraduates of Medicine

基　　金：河北省医学科学研究重点课题计~（20090387）

摘　　要：目的对照观察右美托咪定和咪达唑仑对困难气道患者经鼻纤维支气管镜插管血流动力学和镇静的影响。方法40例ASA分级Ⅰ～Ⅱ级择期手术困难气道患者按住院号奇偶数分为咪达唑仑组（M组）和右美托咪定组（D组），每组20例。M组静脉注射咪达唑仑0．03mg／kg，D组10min内恒速泵入右美托咪定1μg／kg，然后施行经鼻纤维支气管镜插管。记录麻醉前（T0）、纤维支气管镜通过后鼻孔（T1）、窥视会厌（T2）、插管成功即刻（T3）、插管后1min（T4）、插管后3min（T5）时收缩压、舒张压、平均动脉压（MAP）、心率、脉搏血氧饱和度（SpO2）的变化，Ramsay镇静评分，心率收缩压乘积（RPP），末梢灌注指数（TPI），气道评分，术后随访24h。结果M组T1～T3收缩压、舒张压、MAP、心率、RPP均较Tn和D组同一时间点显著升高（P〈0．05），D组改变差异无统计学意义（P〉0．05）。M组T1-T3 Ramsay评分、TPI显著低于T0（P〈0．05），D组T1-T5 Ramsay评分、TPI显著高于T0（P〈0．05），D组T，～T5Ramsay评分、TPI显著高于M组同一时间点（P〈0，05）。D组气道评分1分率、插管满意率[100％（20／20）、90％（18／20）]显著高于M组[30％（6／20）、50％（10／20）]（P〈0．05）。D组咽喉疼痛发生率[5％（1／20）]显著低于M组[35％（7／20）]（P〈0．05）。结论困难气道患者应用右美托咪定行经鼻纤维支气管镜插管时血流动力学稳定，镇静效果满意。Objective To study the effect of dexmedetomidine and midazolam on hemodynamics and sedation in patients with nasal intubation. Methods Forty patients whose ASA grade Ⅰ～Ⅱ and anticipated difficult airway were randomly divided into dexmedetomidine group （group D,20 cases） and midazolam group （group M, 20 cases） according to the admission number. In group D, dexmedetomidine 1 g/kg were constant speed pumped in 10 minutes. In group M, midazolam 0.03 mg/kg were intravenous injected. Then nasal intubation were carried. Systolic blood pressure （SBP）, diastolic blood pressure（DBP）, mean arterial blood pressure （MAP）,heart rate （HR）, pulse oxygen saturation （SpO2）,Ramsay sedation score, rate-pressure product （RPP）, tip perfusion index （TPI） were recorded and compared before anesthesia （T0）, fiberoptic bronchoscope pass by later nostril（T1 ）, to spy on epiglottis （T2）, intubation succeed （T3）, after intubation 1 minute （T4） and after intubation 3 minutes （T5）. Airway score and postoperative visit were evaluated. Results SBP, DBP, MAP, HR, RPP in group M were significantly higher at TI-T3 than those at T0 （P 〈 0.05 ）, and were significantly higher than those in group D at the same time （P 〈 0.05 ）. There was no significant difference in group D （P 〉0.05）. Ramsay sedation score and TPI at T1-T3 in group M were significantly lower than those at To （P 〈 0.05）. Ramsay sedation score and TPI at T1-T5 in group D were significantly higher than those at To （P 〈 0.05 ）, and were significantly higher than those in group M at the same time（P 〈 0.05 ）. The rate of airway score 1 score and intubation satisfaction in group D were significantly higher than those in group M [ 100% （ 20/20 ） vs. 30% （ 6/20 ）, 90% （ 18/20 ） vs.50% （ 10/20 ） ] （ P 〈 0.05 ）. The rate of throat ache in group D was significantly lower than that in group M [ 5 % （ 1/20 ） vs. 35 % （ 7/20 ） ] （P 〈 0.05 ）. Conclusions For difficu

关 键 词：导管插入术 血液动力学过程 清醒镇静 右美托咪啶 困难气道 

分 类 号：R614[医药卫生—麻醉学]