右美托咪定复合表面麻醉对保留自主呼吸患者经鼻盲探气管插管应激反应的影响  

Effect of dexmedetomidine complexing topical anesthesia on stress reaction in spontaneous breathing patients receiving nasotracheal blind intubation

作　　者：习建华[1] 邓芳[1] 王丽华[1] 叶雯[1] 

机构地区：[1]杭州市第一人民医院麻醉科,浙江杭州310006

出　　处：《上海医学》2014年第4期288-291,共4页Shanghai Medical Journal

摘　　要：目的研究右美托咪定复合表面麻醉对保留自主呼吸患者经鼻盲探气管插管应激反应的影响。方法选择需行经鼻气管插管全身麻醉的手术患者46例,随机分入右美托咪定组和咪达唑仑复合芬太尼组(咪达唑仑组),每组23例。均先对两组患者的咽喉和气管进行充分的表面麻醉。右美托咪定组患者于气管插管前10min经静脉输液泵注射1μg/kg右美托咪定,之后以0.5μg·kg-1·h-1持续经静脉输液泵注射。咪达唑仑组患者于气管插管前5min静脉注射30μg/kg咪达唑仑和1μg/kg芬太尼。再应用盲探气管插管装置进行经鼻气管插管。记录气管插管成功率、气管插管时间(从开始置入食管气道引导管至气管导管置入确定所需的时间)。分别于气管插管前(T0,右美托咪定组和咪达唑仑组分别为气管插管前10和5min)、光索置入气道后即刻(T1)、经光索引导气管插管置入气管后30s(T2)各时间点,观察心率(HR)、收缩压(SBP)、脉搏血氧饱和度(SpO2)的变化;测定血浆皮质醇和血糖水平,进行警觉/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(P值均>0.05)。两组的气管插管成功率均为100%。两组间气管插管时间的差异无统计学意义(P>0.05)。咪达唑仑组在T1和T2时间点的HR和SBP均显著高于同组T0时间点和右美托咪定组同时间点(P值均<0.01)。两组患者在各时间点的SpO2均维持在95%以上。随着刺激时间的增加,两组患者的皮质醇和血糖水平相应升高,在T2时间点达到最高水平,但右美托咪定组组内不同时间点间的差异均无统计学意义(P值均>0.05),而咪达唑仑组在T1和T2时间点的皮质醇和血糖水平均显著高于同组T0时间点和右美托咪定组同时间点(P值分别<0.01、0.05)。右美托咪定组和咪达唑仑组在T1和T2时间点的OAA/S评分均显著低于同组T0时间点(P值均<0.01),咪达唑仑组在T1和T2时间点的OAAObjective To research the effect of dexmedetomidine complexing topical anesthesia on stress reaction in spontaneous breathing patients undergoing nasotracheal blind intubation. Methods Forty-six patients undergoing nasotracheal intubation were randomly divided into dexmedetomidine group （group D） and midazolam- fentanyl group （group M）. There were 23 patients in each group. Topical anesthesia in throat and trachea was performed in every patient. The patients in group D received intravenous injection of 1 μg/kg dexmedetomidine for 10 minutes before intubation, followed by continued injection of 0. 5 μg kg-1 h-1 dexmedetomidine. The patients in group M received intravenous injection of 30 μg/kg midazolam and 1μg/kg fentanyl for 5 minutes before intubation. Nasotracheal intubation was performed through blind intubation device. The achievement rate of tracheal intubation and intubation time （between placing esophageal airway guide tube and tracheal catheter） were recorded. Heart rate （HR）, systolic blood pressure （SBP） and pulse oxygen saturation （SpO2） were observed before intubation （T0, 10 and 5 minutes before intubation in group D and group M, respectively）, immediately after inserting light wand （T1） and 30 seconds after inserting endotracheal tube （T2）. Concentrations of cortisol and blood sugar were monitored. Observe＇s assessment of alertness/sedation （OAA/S） were performed at all time points. Results There were no significant differences in age, gender, body mass index （BMI） or intubation time between the two groups （all P〈0.05）. The intubation was successfully performed in every patient. HR and SBP at T1 and T2 in group M were significantly higher than those at To and those in group D （all P〈0.01）. SpO2 were more than 95% at every time point in two groups and the concentrations of cortisol and blood sugar reached the peak at T2. There was no significant difference in the concentrations of cortisol and blood sugar between different time points i

关 键 词：右美托咪定 经鼻气管插管 盲探气管插管装置 应激反应 

分 类 号：R614[医药卫生—麻醉学]