右美托咪定在困难气道盲探气管插管中的应用  

Application of dexmedetomidine in difficult airway patients with blind tracheal intubation

作　　者：胡蓉[1] 姜虹[1] 朱也森[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院麻醉科,上海200011

出　　处：《上海医学》2012年第12期994-997,共4页Shanghai Medical Journal

摘　　要：目的评价右美托咪定在困难气道盲探气管插管装置经鼻清醒气管插管中的临床应用价值。方法将50例患者随机分入右美托咪定组和咪达唑仑组,每组25例。右美托咪定组于插管前15min(T0)静脉注射1.0μg/kg右美托咪定,注射时间10min。咪达唑仑组于插管前5min(t0)静脉注射0.02mg/kg的咪达唑仑及2μ/kg的芬太尼。两组均应用盲探气管装置对患者进行经鼻气管插管,观察两组的插管成功率,插管时间,T0(t0)、光索置入气道即刻(T1)及经光索引导气管导管置入气管即刻(T2)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱合度(SpO2)、呼吸频率(RR)及警觉与镇静评分(OAA/S评分)。结果两组间性别构成、年龄和体质指数的差异均无统计学意义。两组间的插管成功率及插管时间的差异均无统计学意义(P值均>0.05)。右美托咪定组T1、T2时间点的HR分别显著慢于咪达唑仑组同时间点(P值均<0.01)。右美托咪定组T1时间点的RR显著快于咪达唑仑组同时间点(P<0.05)。右美托咪定组患者T1时间点的OAA/S评分显著低于咪达唑仑组同时间点(P<0.05)。两组各时间点间MAP的差异均无统计学意义(P值均>0.05)。整个气管插管过程中,两组使患者SpO2均维持于95%～100%。结论右美托咪定诱导下盲探气管装置经鼻清醒插管使患者的血流动力学更稳定,镇静程度更理想。Objective To assess the value of dexmedetomidine in difficult airway patients receiving awake nasotracheal intubation with blind intubation device under topical anesthesia. Methods Fifty patients with difficult airway from oral maxillofacial department were randomly divided into two groups （n=25）. The patients in dexmedetomidine group received intravenous injection of 1.0 μg/kg dexmedetomidine for 10 mins at 15 mins before intubation （T0）. The patients in midazolam group received intravenous injection of 0.02 mg/kg midazolam and 2 μ/kg fentanyl at 5 mins before intubation （to）. Awake nasotracheal intubation was applied with blind intubation device. The success rates of intubation, intubation time, and heart rate （HR）, mean arterial pressure （MAP）, saturation pulse oxygen （SpO2）, respiratory rate （RR） and observer＇s assessment of alertness/sedation （OAA/S） score at the time point of To or to, T; （immediately after inserting lightwand） and T2 （immediately after inserting the tracheal tube guided by lightwand） were observed. Results There were no significant differences in age, gender, body mass index （BMI）, success rates of intubatien or intubation time between the two groups （all P;〉 0.05）. HR at T; and T2 in dexmedetomidine group were significantly lower than those in midazolam group （all P〈 0.01）. Compared with those in midazolam group at T;, RR was significantly increased and OAA/S score was significantly decreased in dexmedetomidine group （ P〈0.05）. There was no significant difference of MAP at each time point between the two groups （P 〉 0.05）. SpO2 maintained at 95% to 100% during intubation in both two groups. Conclusion Under the induction of dexmedetomidine, stable hemodynamics and ideal sedation can be achieved in patients receiving awake nasotracheal intubation with blind tracheal device.

关 键 词：右美托咪定 清醒经鼻插管 盲探气管插管装置 

分 类 号：R614[医药卫生—麻醉学]