强直性脊柱炎患者右美托咪定辅助表面麻醉纤维支气管镜引导经鼻清醒插管的临床应用观察  

Application of fiberoptic bronchoscopic-assisted nasotracheal intubation under awake induction with dexmedetomidine in ankylosing spondylitis patients

作　　者：邵雪泉[1] 余洁[1] 潘中心[1] 郑丽花[1] 徐玲[1] 江秀清[1] 

机构地区：[1]浙江省衢州市人民医院麻醉科,324000

出　　处：《中华全科医师杂志》2015年第2期132-135,共4页Chinese Journal of General Practitioners

基　　金：浙江省医学会科研基金项目（2013ZYC-A127）

摘　　要：将60例预计插管困难而拟行纤维支气管镜（FOB）引导经鼻清醒气管插管后外科手术的强直性脊柱炎（AS）患者,随机分组分别行表面＋右美托咪定（DEX） 1.0 μg/kg（10 min内静脉输注）负荷量麻醉（DEX组）和表面＋静脉注射咪达唑仑0.05 mg/kg、芬太尼3μg/kg麻醉（MF组）,保留自主呼吸经鼻插管.DEX组平均动脉压（MAP）、心率在FOB通过后鼻孔、窥视会厌、插管成功即刻及后1 min均低于MF组（P＜0.05或＜0.01）,Ramsay镇静评分高于MF组（P＜0.05）;插管舒适度5级评分,DEX组1、2级者为8和14例,高于MF组的4和10例;插管后即刻3级评分1级者,DEX组21例、MF组12例;气管插管首次成功率DEX组为70％（21例）、MF组47％（14例）（P＜0.05）.术后DEX组对鼻腔置入FOB及插管刺激不良记忆率为37％（11例）,明显低于MF组的67％（20例）（P＜0.05）.提示DEX辅助气道表面麻醉行FOB引导经鼻清醒气管插管,患者舒适度和配合度高,并能提供更好的气管插管条件.A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine （D） or midazolam plus sufentanil （MF） group.Group D：topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF：intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic （FOB）-assisted awake nasotracheal intubation was performed.Mean arterial pressure （MAP）,heart rate （HR）,Pulse oxygen saturation （SpO2）,Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris （T1）,peep the epiglottis（T2）,intubation success immediately（T3）and 1 min after intubation（T4） were significantly lower （P 〈 0.05 or P 〈 0.01） than those of group MF while Ramsay sedation scores were obviously higher （P 〈 0.05） than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D （n =21） were significantly higher than group MF （n =12） ; initial success rate of intubation in group D was obviously higher than that in group MF （70%,n =21 vs.47%,n =14）.And the incidence of unpleasant intubation memory in group D was lower than that in group MF （37%,n =11 vs.67%,n =20）.Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.

关 键 词：脊柱炎 强直性 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]