右美托咪啶用于颌面外科手术清醒纤维支气管镜插管镇静的临床研究  

Clinical application of dexmedetomidine as a sole sedative used in maxillofacial surgery for awake fiberoptic intubation in patients with difficult airways

作　　者：范慧慧[1] 范莹盈[1] 徐浩[1] 孟祥忠[1] 张惠[1] 徐礼鲜[1] 

机构地区：[1]第四军医大学口腔医学院麻醉科,西安710032

出　　处：《实用口腔医学杂志》2012年第2期223-226,共4页Journal of Practical Stomatology

摘　　要：目的:观察右美托咪啶(Dexmedetomidine,Dex)用于颌面外科清醒纤维支气管镜插管镇静的临床效果。方法:选择40例颌面外科手术患者,采用随机数分组:A组为右美托咪啶组,B组为咪达唑仑+芬太尼组,每组各20例。A组给予右美托咪啶1μg/kg,静脉泵注10 min、速度为6μg/(kg.h);B组咪达唑仑2 mg+芬太尼0.05 mg静脉推注,当患者警觉/镇静(OAA/S)评分达3分,BIS值小于85时,应用1%利多卡因喷雾实施完善的上呼吸道表面麻醉,随后开始纤维支气管镜插管。观察比较2组给药前(T0),镇静程度达3分,BIS小于85时(T1),气管插管成功即刻(T2)和气管插管后5 min(T3)的OAA/S评分、心率(HR)、血压(BP)、脉搏氧饱和度(SPO2)、脑电双频指数(BIS),T0和T3时血浆中去甲肾上腺素(NE)和肾上腺素(E)浓度,T1时右美托咪啶用药量,以及患者对插管的合作度和遗忘率。结果:A组用药后心率明显减慢且低于B组(P<0.05);插管后2组血压与T0比较都升高(P<0.05);用药后2组SPO2都下降,但A组明显高于B组(P<0.05);2组NE、E水平明显升高,但A组低于B组(P<0.05)。结论:单独给予右美托咪啶可以产生良好的镇静镇痛效应,能明显抑制插管引起的应激反应,可单独辅助清醒纤维支气管镜插管,但需注意心动过缓的发生。Objective： To observe the clinical effects of dexmedetomidine（Dex） used in maxillofacial surgery for awake intubation in patients with difficult airways.Methods： 40 patients were randomly and equally divided into two groups.Patients in group A received Dex at loading of dose 1 μg/kg for 10 minutes with the rate of 6 μg/（Kg·h）;those in group B received midazolam 2 mg and fentanyl 0.05 mg.When the patients＇ expression of alertness/sedation（OAA/S） reached to 3,and BIS was less than 85,patients in the two groups were received enough topical anesthetics to the airway.Then awake fiberoptic intubation was administered.OAA/S,HR,MAP,SPO2 as well as BIS were recorded before drug administration（T0）,when OAA/S reached to 3 and BIS was less than 85（T1）,success of intubation（T2） and 5 minutes after intubation（T3）;serum level of norepinephrine（NE） and epinephrine（E） were measured at T0 and T3.The total dose of Dex application quantity along with patients＇ cooperation of intubation and amnesia was recorded.Results： HR in group A slowed down obviously and it was less than in group B after using the drug（P0.05）.BP in the two groups rised after intubation（P0.05）,SPO2 in the two groups lowered after using the drugs and was higher in group A than in group B（P0.05）,serum NE and E in the two groups increased significantly,but in group A it was lower than in group B（P0.05）.Conclusion： Dex has desirable sedation and analgesia effects and may be used alone for awake intubation alone.Attention should be paid for the prevention of bradycardia.

关 键 词：右美托咪啶 颌面外科手术 纤维支气管镜 经鼻清醒气管插管 

分 类 号：R782.054[医药卫生—口腔医学]