右美托咪定在巨大甲状腺肿瘤手术中的应用  

APPLICATION OF DEXMEDETOMIDINE IN OPERATION FOR GIANT THYROID NEOPLASMS

作　　者：张文龙[1] 于美华[1] 何丽云[1] 卢承志[1] 刘建东[1] 

机构地区：[1]中国人民解放军第175医院麻醉科,福建漳州363000

出　　处：《齐鲁医学杂志》2015年第6期641-643,646,共4页Medical Journal of Qilu

摘　　要：目的探讨右美托咪定联合视频喉镜引导气管插管在巨大甲状腺肿瘤手术中的应用效果。方法选择气管内全麻下行巨大甲状腺肿瘤手术病人38例,ASAⅡ或Ⅲ级,术前气道评估Mallampati分级为Ⅲ或Ⅳ级,随机分为两组,A组静注右美托咪定（Dex）1μg/kg（10 min内注完）联合视频喉镜引导插管;B组静注咪达唑仑0.04mg/kg＋芬太尼2μg/kg联合纤维支气管镜引导插管。记录两组入室时（T0）、诱导前（T1）、诱导后即刻（T2）、气管导管进入声门即刻（T3）、插管后2min（T4）、插管后5min（T5）时的平均动脉压（MAP）、心率（HR）;观察记录气管插管的成功率、时间、有无躁动和呛咳等插管不良反应;术后随访病人有无咽喉肿痛及对插管过程是否耐受。结果两组T2、T3、T4、T5时点MAP较T0时点明显降低（F=14.96、17.05,P〈0.01）;A组T1、T3、T4时点血氧饱和度（SpO2）较T0时点明显降低（F=7.55,P〈0.01）,B组T2、T3、T4、T5时点SpO2较T0时点明显降低（F=16.89,P〈0.01）;A组T2、T3、T4、T5时点HR较T0时点明显降低（F=34.05,P〈0.01）,B组T2时点HR较T0时点明显降低（F=8.60,P〈0.01）。组间比较,B组T2、T4、T5时点SpO2较A组明显降低（t=3.94~7.72,P〈0.01）,B组T2、T3、T4、T5时点HR较A组明显升高（t=2.05~5.72,P〈0.05）。A组均一次插管成功,无躁动、呛咳等发生。B组2例因气管内严重受压,气管管腔狭窄,直径4.5 mm气管导管无法套入纤维支气管镜,导致插管失败,加压给氧,更换视频喉镜引导进行气管内插管均1次成功;在诱导时出现轻微呛咳9例,躁动4例,追加丙泊酚用量,气管插管时不再出现。A组插管时间较B组明显缩短（t=3.59,P〈0.01）,呛咳比例较B组明显减少（χ2=9.32,P〈0.01）。结论右美托咪定联合视频喉镜引导清醒气管插管在巨大甲状腺肿瘤手术中应用安全有效,插管时间短,成功率高,插管时血流动力学稳定,并发症少。Objective To assess the effects of dexmedetomidine（Dex）combined with Glide Scope video laryngoscopeguide tracheal intubation in surgery for patients with giant thyroid neoplasms（GTNs）. Methods Thirty-eight patients scheduled for GTN surgery under general endotracheal anesthesia,ASA Ⅱ or Ⅲ,were selected,and randomized to two groups as groups A and B according to preoperative airway assessment of Mallampati gradeⅢ orⅣ.Patients in group A were givenⅣ Dex（1μg/kg,completed in 10min）combined with video laryngoscopy for intubation,and those in group B receivedⅣinjection of midazolam（0.04mg/kg）plus fentanyl（2μg/kg）combined with fibrotic bronchoscopy for intubation.Mean arterial pressure（MAP）and heart rate（HR）of patients in the two groups were recorded while entering operating room（T0）,before induction（T1）,immediately after induction（T2）,immediately when tracheal catheter got into the glottis（T3）,2 min after intubation（T4）and5min after intubation（T5）.The success rate of tracheal intubation,time spent,and adverse reactions such as restlessness or bucking were observed and recorded as well.Postoperative follow-up was conducted for if there were swelling and pain in throat,and whether or not tolerated tracheal intubation. Results The MAP of T2,T3,T4,and T5time-point in both groups was significantly lower than that of T0（F=14.96,17.05;P〈0.01）;In group A,the SpO2 of T1,T3,and T4time-point declined versus that of T0（F=7.55,P〈0.01）,and in group B,the SpO2 of T2,T3,T4,and T5 were lower than that of T0 time point（F=16.89,P〈0.01）.As for HR,in group A,that decreased at T2,T3,T4,and T5 versus T0（F=34.05,P〈0.01）,and in group B,the HR at T2 was much lower than that at T0（F=8.60,P〈0.01）.A comparison between the two groups showed that：in group B,the SpO2 of T2,T4,and T5 was lower than group A（t=3.94-7.72,P〈0.01）,and HR of T2,T3,T4,and T5 in group B higher than group A（t=2.05-5.72,P〈0.05）.In group A,the success rate of one-attempt

关 键 词：右美托咪定 喉镜检查 甲状腺肿瘤 

分 类 号：R736.1[医药卫生—肿瘤]