右旋美托咪啶与咪达唑仑在老年高位颈椎骨折患者清醒气管插管中的镇静作用  

Comparison of Dexmedetomidine and Midazolam for sedation in elderly patients with upper cervical spine fracture in awake tracheal intubation

作　　者：钟丽敏[1] 靳丽敏[1] 姜亚辉[1] 

机构地区：[1]苏州大学附属第一医院麻醉科,215006

出　　处：《中华老年医学杂志》2015年第9期1000-1002,共3页Chinese Journal of Geriatrics

摘　　要：目的比较有旋美托眯啶与咪达唑仑对老年高位颈椎骨折清醒患者气管插管中镇静作用。方法选择我院2010年1月至2015年1月收治的老年高位颈椎骨折择期行清醒气管插管全麻手术治疗的68例患者为研究对象。随机分为右旋美托咪啶组和咪达唑仑组，其中右旋美托咪啶组34例，采用右旋美托咪啶麻醉诱导；眯达唑仑组34例，采用咪达唑仑麻醉诱导；对比分析两组患者入室后麻醉前（T1）、气管插管前即刻（T2）和插管后即刻（T3）患者心率、平均动脉压和脑电双频谱指数值（BIS）值，插管前后二氧化碳分压（PaCO2）值以及不良反应发生情况。结果T1时刻两组患者心率、平均动脉压和BIS比较差异无统计学意义（P〉0．05）。T2和T3时刻右旋美托咪啶组患者心率、平均动脉压和BIS均明显低于咪达唑仑组（P〈0．010）。气管插管前后两组患者组内和组间PaCO2值比较差异无统计学意义（P〉0．05），两组不良反应发生率比较差异无统计学意义（χ^2=1．308，P=0．253）。结论与咪达唑仑比较右旋美托咪啶用于高位颈椎骨折患者清醒气管插管可更好稳定患者心率、平均动脉压和BIS，安全性好，值得临床应用。Objective To compare the effects of Dexmedetomidine and Midazolam for sedation in elderly patient with upper cervical spine fracture in awake tracheal intubation. Methods A total of 68 patients with upper cervical spine fracture undergoing awake tracheal intubation who treated in our hospital from Jan. 2010 to Jan. 2015 were considered as the objects, who was randomly divided into group A and group B. 34 cases in group A were treated with Dexmedetomidine for sedation, and the other 34 cases in group B were treated with Midazolam for sedation. The Heart rate （HR）, mean arterial pressure （MAP） and BIS value on the before anesthesia （T1）, immediately before intubation （T2）, immediately after intubation （T3）, PaCO2 in before and after intubation, and the adverse reactions were compared between the two groups. Results There was no difference in HR, MAP and BIS at time of T1 between the two groups （P〉0.05）. The HR, MAP and BIS were lower in group A than in group B at time of T2 and T3 （P〈0.01）. The PaCO2 had no difference between the two groups at before and after intubation （P〉0.05）. The rate of adverse effects had no difference between the two groups （ χ^2=1. 308, P=0. 258） . Conclusions Compared with Midazolam, Dexmedetomidine can stable HR, MAP and BIS effectively and has a good safety in the treatment of elderly upper cervical spine fracture in awake tracheal intubation, which is worthy of clinical application.

关 键 词：右美托咪啶 咪达唑仑 颈椎 骨折 插管法 气管内 

分 类 号：R614[医药卫生—麻醉学]