不同剂量右美托咪啶在清醒气管插管中最适剂量的比较  

The optimal dosage of dexmedetomidine in awake tracheal intubation

作　　者：徐尚军[1] 洪方晓[2] 周国庆[1] 田鸣[2] 

机构地区：[1]首都医科大学平谷区医院麻醉科,101200 [2]首都医科大学附属北京友谊医院麻醉科

出　　处：《北京医学》2013年第1期26-29,共4页Beijing Medical Journal

摘　　要：目的探讨不同剂量右美托咪啶(dexmedetomidine,Dex)复合舒芬太尼用于清醒气管插管的最适剂量。方法择期全麻手术患者60例,随机分为3组,每组20例。患者入室后静脉给予阿托品0.3mg,监护吸氧,静息5min后静脉推注舒芬太尼5μg,同时静脉泵注Dex10min(A组:0.5μg/kg,B组:0.75μg/kg,C组:1.0μg/kg);Dex输注6min后行气道表面麻醉;Dex输注完成5min后,经口气管插管。记录给药及插管过程中的血流动力学和呼吸指标的变化情况,同时记录Ramsay镇静评分、诱导期间不良反应,评估气管插管条件。术后24h对患者进行随访。结果 B组插管前镇静评分为(4.3±0.7)分,高于A组的(3.3±0.4)分(P<0.05);C组为(4.6±0.7)分,显著高于B组(P<0.05)。A组插管后心率由(63.7±6.7)次/min升高到(72.4±7.1)次/min(P<0.05);B组由(64.9±6.3)次/min升高到(65.8±6.0)次/min;C组由(60.9±7.8)次/min升高到(61.6±7.2)次/min,但差异无统计学意义(P>0.05)。B、C组插管后血压较插管前无明显改变(P>0.05)。A、B组心血管不良反应发生率均为5%,C组为30%(P<0.05)。B组患者对插管的总体满意度为(1.7±0.6)分、C组为(1.6±0.6)分,优于A组的(2.2±0.7)分(P<0.05)。结论 Dex复合舒芬太尼可以有效用于清醒气管插管。Dex0.75μg/kg复合舒芬太尼5μg,可以显著抑制气管插管应激反应,是较为合理的临床用药剂量。Objective To explore the optimal dosage of dexmedetomidine（Dex） combined with sufentanil in awake tracheal intubation. Methods Sixty patients scheduled to receive general anesthesia were randomly divided into three groups ：group A,group B and group C, twenty patients in each group. Patients were monitored routinely, sufentanil 5μg were given for the induction, then Dex was given over ten minutes by micro-injection pump （group A： 0.5μg/kg, group B： 0.75μg/kg, group C： 1.0μg/kg） . Airway anesthesia was performed six minutes after Dex infusion. Five minutes after Dex completion, tracheal intnbation was performed. Fluctuations in the hemodynamic and respiratory indicators were monitored. Then ramsay sedation scale, other side-effects and the assessment of intubating conditions were observed. The overall satisfaction of intubation was recorded in patients in twenty-four hours. Results （1）The ramsay sedation scale before intubation in group B （4.3±0.7）points was higher than that in group A （3.3±0.4）points, p〈0.05. The ramsay sedation scale before intubation in group C （4.6±0.7）points was higher than that in group B （4.3±0.7）points, p〈0.05. （2）After intubation, the HR increased from （63.7±6.7） beats/rain to （72.4±7.1） beats/rain in group A（P 〈 0.05）, there was no significant change in group from （64.9±6.3） beats/min to （65.8±6.0） beats/min] and in group Cfrom （60.9±7.8） beats/min to （61.6±7.2） beats/min]（P 〉 0.05）. （3）The incidence of cardiovascular adverse reactions was 1/20 in group A and B, which was lower than that in group C （6/20, P 〈 0.05）. （4）The overall satisfaction of intubation of patients in group B （1.7±0.6 points）and C （1.6±0.6 points） was higher than that in group A （2.2±0.7 points）（P 〈 0.05 ）. Conclusions （5）Dex combined with sufentanil on the top of superficial anesthesia is effective for awake tracheal intubation. （6）Dex 0.75μg/kg combined with sufentanil 5μg is the

关 键 词：右美托咪啶 舒芬太尼 气管插管 最适剂量 

分 类 号：R614[医药卫生—麻醉学]