右美托咪定联合插管型喉罩在困难气道插管中的应用  

Effects of dexmedetomidine combined with intubating laryngeal mask airway on tracheal intubation in predictive difficult airway patients

作　　者：陈恭达[1] 夏瑞[1] 毛庆军[1] 尹泓[1] 别世杰[1] 郑吉卫[1] 

机构地区：[1]长江大学第一附属医院麻醉科,湖北省荆州市434000

出　　处：《临床麻醉学杂志》2013年第2期129-132,共4页Journal of Clinical Anesthesiology

摘　　要：目的评价右美托咪定诱导联合插管型喉罩或纤维支气管镜(FOB)在清醒保留呼吸情况下气管插管的效果。方法择期手术全麻患者96例,ASAⅡ或Ⅲ级,术前气道评估Mallampati分级≥Ⅲ级,Cormack-Lehane分级≥Ⅲ级。随机均分为四组:A组静注右美托咪定1μg/kg(10min)+芬太尼2μg/kg联合插管型喉罩插管;B组静注咪达唑仑0.03mg/kg+芬太尼2μg/kg联合插管型喉罩插管;C组静注右美托咪定1μg/kg(10min)+芬太尼2μg/kg经鼻FOB插管;D组静注咪达唑仑0.03mg/kg+芬太尼2μg/kg经鼻FOB插管。记录麻醉前(T0)、静脉推注右美托咪定或咪达唑仑完毕即刻(T1)、静脉推注芬太尼后(T2)、置入插管型喉罩或FOB到达会厌即刻(T3)、插入气管导管时(T4)、插入气管导管后1min(T5)、插入气管导管后给予肌松药后3min(T6)时MAP、HR、SpO2、BIS,并记录插管成功率、心动过速、高血压、有无躁动、呛咳等插管反应,记录插管前心动过缓使用阿托品和插管后的心动过速使用艾司洛尔情况,术后随访患者对插管过程是否耐受。结果与T0时比较,T2、T3时A、C组HR明显减慢,T3～T5时B、D组HR明显增快,T3～T5时B、D组和T4、T5时C组MAP明显升高(P<0.05)。诱导插管前阿托品使用率A、C组明显高于B、D组;插管后艾司洛尔使用率A、C组明显低于B、D组(P<0.05);术后躁动发生率A、B、C组均明显低于D组(P<0.05);对麻醉中插管的耐受、下次是否愿意使用同样的麻醉方法A组均明显高于B、C、D组(P<0.05)。结论右美托咪定联合插管型喉罩在困难气道保留呼吸插管安全有效,而且可以减少心动过速、高血压及心肌缺血发生率,增强对气管插管的耐受。Objective To evaluate the effect of dexmedetomidine combined with intubating laryngeal mask airway （ILMA）or fiberoptic bronchosopy（FOB） on tracheal intubation in difficult airway patients. Methods Total of ninty-six patients scheduled for elective surgery and general anesthesia, whose ASA ]1 or 111, preoperative Mallampati score ≥Ⅲ, Cormack-Lehane≥ Ⅲ were randomly divided into 4 groups （n = 24 each）. Group A was infused dexmedetomidine 1 μg/kg （10 rain） ＋ fentanyl 2μg/kg combined with ILMA during induction. Group B was infused midazolam 0.03 mg/kg＋ fentanyl 2/ag/kg combined with ILMA. Group C was infused dexrnedetomidine 1 μg/kg（10 min） ＋ fentanyl 2μg/kg combined with FOB. Group D was infused midazolam 0.03 mg/kgna fentanyl 2 /~g/kg combined with FOB. HR, MAP, BIS were continuously monitored and recorded before induction anesthesia （To, baseline）, at the end of intravenous injection of dexmedetomidine or midazolam（T1 ）, after intravenous injection of fentanyl （TO）, at tracheal intubation via the ILMA or FOB arrived to the epiglottis（T3 ）, at inserting the tracheal tube（T4 ）, 1 rain after tracheal tube（T0 ）, 3 mins after intravenous injection propofol and muscle relaxant （T6）. The intubation time, rate of successful intubation and incidences of complications were all recorded. The usage of atropine for bradycardia before intubation and esmolol for tachycardia after intubation were recorded. The patients were followed-up at 1 day after operation for personal satisfaction investigation. Results Compared with To, HR in groups A and C at T2,T3 were obviously slower and in groups B and D at T3-T5 werefaster; and the MAP in groups B and D at T5-T11 and in group C at T1 were significantly increased（P 〈0.05）. The usage of atropine before intubation in groups A and C were higher than groups B and D;and esmolol after the intubation were lower（P〈0.05）. The rate of restlessness in group D was obviously higher than the other groups（P〈0.05）. The

关 键 词：右美托咪定 纤维支气管镜 插管型喉罩 血流动力学 气管内插管 

分 类 号：R614[医药卫生—麻醉学]