右旋美托咪定复合丙泊酚TCI用于经鼻清醒镇静气管插管的可行性  

DEXMEDETOMIDINE COMBINED WITH PROPOFOL TARGET-CONTROLLED INFUSION FOR SEDATION DURING AWAKE NASOTRACHEAL INTUBATION:A STUDY OF ITS SAFETY AND FEASIBILITY

作　　者：祝琳[1] 董河[1] 张晓[1] 黄辉[1] 李欢妮 

机构地区：[1]青岛大学附属医院麻醉科,山东青岛266003 [2]青岛市口腔医院麻醉科

出　　处：《青岛大学医学院学报》2015年第2期184-186,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的观察右旋美托咪定复合丙泊酚靶控输注（TCI）麻醉用于纤维支气管镜引导经鼻清醒镇静气管插管的安全性和可行性。方法选择可疑困难气管插管的择期手术病人60例,诱导前进行鼻腔准备＋上呼吸道表面麻醉＋环甲膜穿刺,10min内静脉泵注完右旋美托咪定诱导量（0.5μg/kg）后,丙泊酚TCI设定起始血浆靶浓度为0.5mg/L,递增梯度为0.1mg/L,病人镇静程度达到OAA/S评分3分后,纤维支气管镜引导经鼻插管。分别记录插管时间及插管即刻丙泊酚浓度、脑电双频指数（BIS）值,观察诱导前（T1）、插管即刻（T2）和插管后2 min（T3）的平均动脉压（MBP）、呼吸频率（RR）、心率（HR）。评估插管条件及插管过程中病人的舒适度、耐受气管导管情况。结果所有病人均于4min内顺利完成气管插管,平均丙泊酚浓度（0.83±0.18）mg/L,平均BIS值79.6±3.0。T1、T2、T3时刻病人MAP、HR比较差异有显著性（F=272.12、56.15,q=2.98~39.34,P〈0.05）,RR比较差异无显著性（F=2.58,P〉0.05）。插管条件中咳嗽、声门、肢体运动评分满意率分别为100%、93%、93%,舒适度、耐受情况评分满意率分别为93%、98%。结论右旋美托咪定复合丙泊酚TCI适用于经鼻清醒镇静气管插管,是一种安全有效的麻醉方法。Objective To evaluate the safety and feasibility of combined dexmedetomidine with propofol target controlled infusion （TCI） for sedetion during awake fibreoptic nasotraeheal intubation （FNI）. Methods Sixty patients scheduled for a se lective surgery （who were suspected of difficult tracheal intubation） were enrolled in this study. Before anesthesia induction, nasal cavity was cleaned, superficial anesthesia was done in upper respiratory tract and thyrocricoid puncture carried out. Patients were then received a loading dose of dexmedetomidine （0.5 μg/kg） infused within 10 min. The initial target plasma concentration of propofol was set at 0.5 mg/L. This was adjusted by 0.1 mg/L according to the level of OAA/S during the procedure. Fibreoptic in- tubation was commenced at level three of OAA/S. The intubation time, the concentration of propofol and BIS were recorded. The mean arterial pressure （MAP）, heart rate （HR）, and respiration rate （RR） of the patients before induction （TI）, immediately at intubation （T2）, and at 2 min after intubation （T3） were recorded. Intubation scores, patient tolerance, degree of confort at intu- bation were assessed. Results The intubation procedures were smoothly completed within four minutes in all the patients, with an average propofol dosage of （0.83 ±1.8） mg/L. and average BIS of 79.6±3.0. The differences between MAP and H R in different time points （T1, T2 and T3） were significant （F：272.12,56.15;q=2.98 39.34;P〈0.05）, while that of RRwasnot significant （F=2.58,P〉0.05）. In terms of intubation scoring, cough reflex, glottis movement and body motion were 100% ,93% and 93%, respectively, and the satisfaction rate of degree of confort and tolerance was 93% and 98%. Conclusion Combined dexmedetomi- dine with propofol target-controlled infusion applied to pernasal awake sedating tracheal intubation is the safer and more effective anesthetic method.

关 键 词：右美托咪啶 二异丙酚 麻醉 气管内 插管法 气管内 

分 类 号：R614[医药卫生—麻醉学]