可预料困难气道中右美托咪啶的应用研究  

Application research on dexmedetomidine in predictably difficult airway endotracheal intubation

作　　者：王传光[1] 吴炜[1] 高丽娟[1] 雷李培[1] 赵辉[1] 尧银光[1] 

机构地区：[1]丽水市中心医院麻醉科

出　　处：《中国临床药理学与治疗学》2015年第7期803-807,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省医学会临床科研基金项目(2012ZYC-A107)

摘　　要：目的：探讨不同剂量右美托咪定注射液（dexmedetomidine,DEX）在可预见困难气管插管中的临床疗效。方法：将138位可预见困难气道患者分为A、B、C三组（n=46）,A、B组分别应用DEX 0.6μg/kg、1.0μg/kg,C组使用0.03 mg/kg咪唑安定,分别进行慢诱导麻醉。三组患者在静脉诱导同时给予7 L/min高氧驱动雾化吸入2%利多卡因5 m L行呼吸道表面麻醉。比较三组患者于麻醉诱导前（T1）、纤支镜插入鼻腔时（T2）、纤支镜插达隆突即刻（T3）、插入气管即刻（T4）、插入气管后2 min（T5）5个时点监测的平均动脉压（MAP）、心率（HR）、血氧饱和度（Sp O2）、Ramsay镇静评分以及T1、T4、T5时血浆中去甲肾上腺素（NE）和肾上腺素（E）浓度水平。结果：自T4时起,3组患者血中的NE与E值显著升高,与T1时比较差异具有统计学意义（P〈0.05）。A、B两组患者在T4与T5时NE与E值升高,与C组比较,差异具有统计学意义（P〈0.05）。A、B两组患者在T3~T5时的MAP、HR与Ramsay镇静评分等监测结果与C组比较,差异具有统计学意义（P〈0.05）。A、B两组患者麻醉效果的优良率、气管差管的成功率显著高于C组,差异有统计学意义（P〈0.05）。结论：DEX于插管前进行慢诱导清醒镇静治疗辅以高压雾化吸入利多卡因气管内表面麻醉是安全可行的,能为可预见困难气道患者的清醒气管插管操作提高满意的治疗效果。AIM： To evaluate the efficacy of dexmedetomidine（ DEX） hydrochloride injection in the predictably difficult airway endotracheal intubation. METHODS： 138 patients undergoing predictably difficult airway endotracheal intubation were averagely divided into groups A,B and C（ n = 46）.Groups A and B received slow induction of anesthesia at 0. 6 μg / kg and 1. 0 μg / kg of DEX respectively,and group C received Midazolam（ 0. 03 mg /kg）. Patients in the three groups were given intravenous induction and high-pressure atomization and inhalation of 5 m L of 2% lidocaine at 7 L / min for Respiratory tract surface anesthesia. The MAP,HR and Sp O2 were compared among the three groups at T1,T2,T3,T4 and T5. The plasma concentrations of norepinephrine（ NE） and epinephrine（ E） were compared at T1,T4 and T5. RESULTS： In three groups,compared to T1,the plasma concentrations of NE and E in the other time point were significantly increased（ P〈0. 05）. The plasma concentrations of NE and E in groups A and B at T4 and T5were significantly higher than in group C at the same time point（ P〈0. 05）. The MAP and HR in groups A and B were steady than in group C（ P〈0. 05）. The anesthetic excellent rate and successful endotracheal intubation rate of patients in groups A and B were higher than those in group C,and the difference was significant（ P〈0. 05）. CONCLUSION： DEX supplemented by high-pressure atomization and inhalation of lidocaine for intratracheal surface spacing safer and feasible to take before slow induction of anesthesia,which can improve satisfactorily in the predictably difficult Airway endotracheal intubation.

关 键 词：右美托咪啶 麻醉诱导 困难气道 

分 类 号：R614[医药卫生—麻醉学]