右美托咪定用于清醒纤支镜引导气管插管镇静的临床研究  

Study on Dexmedetomidine for Sedation during Awake Fiberoptic Intubation

作　　者：王翠玉 顾旭华 吴言悟 袁力勇[3] 

机构地区：[1]浙江省慈溪市中医院麻醉科,315300 [2]浙江省宁波市镇海龙赛医院麻醉科,315200 [3]浙江省宁波市第六医院麻醉科,315040

出　　处：《医学研究杂志》2013年第4期121-125,共5页Journal of Medical Research

基　　金：宁波市优秀中青年卫生技术人才项目(2007201)

摘　　要：目的评估右美托咪定(DEX)或瑞芬太尼(REM)用于清醒纤支镜引导气管插管(AFOI)时镇静的安全性与有效性。方法 ASAⅠ～Ⅲ级、择期手术患者50名,随机分为右美托咪定组(DEX组)及瑞芬太尼组(REM组),每组25例。DEX组静脉注射负荷剂量DEX 0.4μg/kg,继以0.7μg/(kg.h)持续静脉注射;REM组静脉注射负荷剂量REM 0.75μg/kg,继以0.075μg/(kg.min)持续静脉注射。记录并比较两组患者的基础值(T0)、置入纤支镜(FOB)时(T1)、置入FOB后1min(T2)、气管导管插入即刻(T3)、气管导管插入后1min(T4)、3min(T5)、5min(T6)的MBP、HR、BIS值;满意的FOB置入及气管插管条件人数比例;FOB置入时间、插管时间及气管插管一次成功率;不良反应及满意度。结果与REM组相比,DEX组患者T1～T66个时间点的MBP、HR、BIS值相似(P>0.05);两组患者FOB置入时RSS评分、FOB置入与气管插管评分、气管插管一次成功率均相似(P>0.05);DEX组FOB置入时间、气管插管时间分别为116.84±27.96s、20.64±6.26s,均长于REM组的90.88±25.16s、12.72±3.10s(P<0.05)。AFOI期间DEX组患者中有3例、REM组有9例出现呼吸抑制(χ2=3.95,P=0.047)。结论 DEX或REM均能为可预见困难气道患者AFOI时提供安全有效的清醒镇静。相比于DEX,REM呼吸抑制的发生率较高,而FOB置入、气管插管的时间则较短。Objective To evaluate the safety and effectiveness of dexmedetomidine versus remifentanil for sedation during awake fi- beroptic intubation（AFOI）. Methods Fifty patients with ASA I -Ⅲ were enrolled in a double - blinded randomized pilot study to re- ceive dexmedetomidine （DEX） or remifentanil （REM） for sedation during AFOI. The DEX group received a loading dose of 0.4μg/kg followed by an infusion of 0. 7μg/（ kg · h）. The REM group received a loading dose of 0. 75μg/kg followed by an infusion of 0. 075μg/ （ kg · min）. Ramsay sedation scale （RSS） score,bispectral index （ BIS）, and heart rate（HR） at the time of baseline（ To ） , FOB place- ment（ T1 ）, lmin after FOB placement（ T2 ）, intubation（ T3 ）, lmin after intubation（ T4 ） ,3min after intubation（ T5 ）, 5min after intubation （T6） were recorded. The time of FOB placement, intubation and first attempt success rate with AFOI,the side effects such as respiratory depression, nausea and vomitting, bradyarrhythmia and the satisfaction of patients were also recorded. Results No significant difference was found between two groups in RSS score, BIS, and HR at the time of T1, T2 ,T3 ,T4 , T5 , T6. The time of FOB placement was longer （116.84±27.96s vs 90.88 ±25.16s,t = 3. 451 ,P = 0. 001 ） in DEX group than that in REM group. The time of intubation was also lon- ger （20.64 ±6.26s vs 12.72±3.10s, t = 5.67 ,P = 0. 000） in DEX group than that in REM group. During AFOI, three patients （12%）in DEX group, and nine patients in REM group developed respiratory depression （X2 = 3.95, P = 0.047 ）. No significant difference was found between two groups in the satisfaction of AFOL Conclusion Combined with tracheal mucosa surface anesthesia, both dexmedetomidine and remifentanil are effective for AFOI. Compared to dexmedetomidine, the rate of respiratory depression is higher and the time of FOB placement and intubation are shorter when remifentanil used.

关 键 词：右美托咪定 瑞芬太尼 纤支镜引导气管插管 清醒镇静 

分 类 号：R971.8[医药卫生—药品]