右美托咪定联合氯胺酮麻醉诱导困难气道插管  

Exploration of Dexmedetomidine Combined with Ketamine Used as Anesthesia Induction for Pre-intubation in Patients with Difficult Airway

作　　者：单可记[1] 王雨平[1] 杨肖蓉[1] 杨吉林[1] 许汪斌[1] 

机构地区：[1]昆明医科大学第一附属医院ICU,云南昆明650032

出　　处：《昆明医科大学学报》2015年第5期108-111,共4页Journal of Kunming Medical University

摘　　要：目的探讨右美托咪定联合氯胺酮在困难气道插管时麻醉诱导的效果及不良反应发生情况.方法困难气道40例,随机分为2组.A组:20例,采用右美托咪定联合氯胺酮插管前诱导;B组:20例,采用咪达唑仑联合芬太尼插管前诱导.若RASS>-1分,A组重复右美托咪定,B组重复咪达唑仑,直至RASS≤-1分.2组患者均保留自主呼吸,诱导成功后均在纤维支气管镜引导下清醒气管插管,比较2组插管所用时间和诱导前(T0)、诱导后(T1)及气管插管后5 min(T2)的HR和MAP的变化,同时观察并记录诱导和插管过程中出现的呼吸抑制,恶心,呛咳和躁动等不良反应.结果 2组一般资料和插管时间以及在T0时MAP、HR差异无统计学意义(P>0.05).T1,T 2时间点B组均小于A组(P<0.01);插管期间,A组的呼吸抑制、恶心、呛咳和躁动发生率低于B组(P<0.05).结论对困难气道清醒插管患者,右美托咪定联合氯胺酮作为插管前诱导对患者心血管干扰小,无明显呼吸抑制,不良反应少、平稳可靠.Objective To explore the anesthesia induction effects of dexmedetomidine combined with ketamine on patients with difficult airway and the incidence of adverse reactions during intubations. Methods 40 patients with difficult airway were admitted into ICU and were randomly divided into two groups. Group A： 20 cases received anesthesia induction intravenously of dexmedetomidine combined ketamine pre-intubation. Group B： 20 cases received anesthesia induction intravenously of midazolam combined with fentanyl pre-intubation. If RASS 〉 -1, additional dexmedetomidine were repeatedly administered for group A, and additional midazolam for group B, until the RASS ≤-1. All patients＇s pontaneous breathing were kept, tracheal intubation were implemented at once guided by fiberobronchoscopy after successful anesthesia induction. We compared the time consumed during the procedure between the two groups, and the changes of HR and MAP at pre-induction （T0）, post-induction （T1） and after 5 min utes of tracheal intubation （T2） . The adverse reactions such as respiratory depression, nausea, bucking and restlessness were observed and recorded during the process of induction and intubation. Results There were no significant differences in demographic characteristics, the time consumed to intubation, and the MAP, HR at T0 between the two groups. Patients＇ MAP and HR had no obvious changes and kept relatively stable in group A, but decreased obviously in group B at Tland T 2 intubations was lower in group A than in group B （P 〈 （P 〈 0.01） . The incidence of adverse reactions during 0.05） Conclusions The anesthesia induction of dexmedetomidine combined with ketamine can be considered as an excellent alternative for the patients with difficult airway to intubate, which does not result in respiratory depression and has less adverse reactions compared to midazolam combined with fentanyl.

关 键 词：镇静 困难气道 右美托咪定 氯胺酮 

分 类 号：R614.2[医药卫生—麻醉学]