小剂量瑞芬太尼复合右美托咪定在经鼻纤维支气管镜气管插管中的应用  

Application of Little Dose of Remifentalil Combined with Exmedetomidine on Fiberoptic Nasaltracheal Intubation.

作　　者：刘德昭[1] 罗晨芳[1] 葛缅[1] 

机构地区：[1]中山大学附属三院麻醉科,广东广州510630

出　　处：《中国伤残医学》2013年第9期33-34,共2页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨右美托咪定复合瑞芬太尼在经鼻纤维支气管镜气管插管中的应用疗效和安全性。方法:选择60例择期全麻手术的患者,先以2%利多卡因进行咽喉喷雾表面麻醉,1%麻黄碱收缩鼻粘膜。随机分为3组,每组各20例:A组静脉泵入右美托咪啶1μg/kg,B组静脉泵入盐酸瑞芬太尼2μg/kg,C组同时静脉泵入右美托咪啶1μg/kg(10分钟泵完)与瑞芬太尼1μg/kg。3组药物均在15分钟内泵完,然后进行纤维支气管镜引导的经鼻气管插管。分别记录3组Koung评分;气道梗阻评分;呼吸抑制和不良事件发生情况;血管活性药的使用情况。并于术后24小时随访,记录咽喉疼痛、声音嘶哑和气管插管知晓情况。结果:(1)B组的Koung评分最高、C组Koung评分最低(均P<0.05);(2)B组插管过程中呼吸抑制发生例数最多、使用阿托品的例数最少、使用美多心安的例数最多(P<0.05);C组使用亚宁定最少(P<0.05);(3)3组术后24小时的咽喉疼痛和声音嘶哑发生率无明显差异(P>0.05);C组的气管插管知晓率最少(P<0.05)。结论:小剂量瑞芬太尼复合右美托咪定可为经鼻纤维支气管镜气管插管提供满意的插管条件,插管应激反应降低,且不良反应较少。Objective：To explore application of little dose of remifentail combined with exmedetomidine on Fiberoptie nasaltraeheal in- tubation （FNI）. Methods：Sixty patients of General anaesthesia were seleeted and randomly divideded into 3 groups each contained 20 patients： Group A received intravenous infusion of exmedetomidine （1 μg/kg） ; Group B received intravenous infusion of remifentail （ 1 μg/kg） and Group C received little dose of remifentail（ 0.5 μg/kg） combined with exmedetomidine （ 1μg/kg）. All drugs were infused in 10 minutes before FNI. , Koung score, the airway obstruction score, respiratory depression and adverse event, Vasoaetive drug usage and related complication ineluding sore throat, hoarseness and tracheal intubation awareness. Results：（1）The values of Koung score was the highest in group B and the lowest in group C （ P 〈 0.05 ） ; （2）In group B, the incidence of respiratory depression was the highest, the usage rates of atropine was the least and the usage rates of Metoprololin was the most（ all P 〈 0.05 ） ; The usage rate of urapidil were the least in group C （ P 〈 0.05 ） ; （3）There were no significant differences of sore throata and hoarseness among 3 groups （ P 〉 0.05 ） and the rate of tracheal intubation awareness was the least. Conclusion： Little dose of remifentail combined with exmedetomidine can Provide satisfactory conditions for Fiberoptic nasaltraeheal intubation, which may reduce the stress response and has fewer adverse reactions.

关 键 词：右美托咪定 瑞芬太尼 经鼻纤维支气管插管 

分 类 号：R683.4[医药卫生—骨科学]