右美托咪定与芬太尼用于急诊饱胃患者清醒气管插管中的比较  

Comparison of dexmedetomidine and fentanyl used for conscious intubation in emergency patients with full stomach

作　　者：王颖[1] 陈懿[2] 周振锋[3] 于静[3] 

机构地区：[1]浙江省天台县妇幼保健所药剂科,浙江台州317200 [2]浙江省天台县中医院药剂科 [3]浙江大学医学院附属第二医院麻醉科

出　　处：《上海医学》2015年第10期763-766,共4页Shanghai Medical Journal

摘　　要：目的探讨急诊饱胃患者在咽腔表面麻醉和经环甲膜穿刺气管内表面麻醉下,右美托咪定(Dex)作为辅助用药用于清醒气管插管的可行性和安全性,并与芬太尼进行比较。方法急诊行腹腔镜下胃穿孔修补手术的患者52例,采用随机数字表法分入Dex组和芬太尼组,每组26例,分别予Dex和芬太尼1μg/kg应用静脉注射泵10min注射完毕。应用2%利多卡因行咽腔表面麻醉和经环甲膜穿刺注射药物行气管内表面麻醉。分别于患者入手术室时(T_0)、辅助药物泵注结束即刻(T_1)和气管插管成功即刻(T_2),记录患者的心率、平均动脉压(MAP)、脉搏血氧饱和度(S_pO_2)和Ramsay镇静评分。记录患者的气管插管耐受度评分,气管插管过程中恶心、呛咳、躁动等气管插管反应的发生情况,以及其他不良事件。术后对患者满意度进行随访,并询问患者对手术操作过程的记忆情况。结果 Dex组T_1和T_2时间点的心率显著低于同组T_0时间点和芬太尼组同时间点(P值均<0.05),Ramsay镇静评分显著高于同组T_0时间点和芬太尼组同时间点(P值均<0.05);T_2时间点的MAP显著低于芬太尼组同时间点(P<0.05)。芬太尼组T_1时间点的心率显著低于同组T0时间点(P<0.05)。Dex组的气管插管耐受度评分和患者满意度评分均显著低于芬太尼组(P值均<0.05),恶心、呛咳和躁动发生率均显著低于芬太尼组(P值均<0.05)。Dex组有1例对手术操作过程无记忆。结论在表面麻醉的基础上,Dex相比于传统药物芬太尼具有镇静效果佳、气管插管耐受性好、无呼吸抑制、血流动力学更稳定和不良反应少的优点,可以安全地用于急诊饱胃患者应用普通喉镜清醒气管插管。Objective To explore the feasibility and safety of dexmedetomidine for conscious tracheal intubation in emergency bellyful patients before topical anesthetics and surface-endotracheal anesthesia, and to compare the outcome with fentanyl. Methods Fifty-two emergency patients underwent laparoscopic repair of perforated peptic ulcer and were randomly divided into dexmedetomidine group and fentanyl group according to random digits table （n = 26）. They received dexmedetomidine or fentanyl at a dose of 1 μg/kg by venous pump for 10 min, respectively. 2% lidocaine was given to perform surface anesthesia through pharyngeal cavity and trachea. Heart rate （HR）, mean artery pressure （MAP）, blood oxygen saturation of pulse （SpO2） and Ramsay sedation scores were recorded before induction （T0）, at the end of drug infusion （T1）, and immediately after successful intubation （T2）. The tolerance to intubation and the incidence of nausea, coughing and restlessness during intubation as well as other adverse events were also recorded. Patient satisfaction and memory information about the surgical procedure were investigated after surgery. Results Compared with those at To in the dexmedetomidine group and at T1 and T2 in the fentanyl group, HR were significantly decreased while Ramsay sedation scores were significantly increased at T1 and T2 in the dexmedetomidine group （all P〈0.05）. MAP in the dexmedetomidine group was significantly lower than that in the fentanyl group at T2 （P〈0.05）. HR at T1 was significantly lower than that at To in the fentanyl group （P 〈 0.05）. The tolerance to intubation and patients＇ satisfaction in the dexmedetomindine group were significantly lower than those in the fentanyl group （both P〈0.05）. The incidences of nausea, coughing and restlessness in the dexmedetomindine group were also significantly lower than those in the fentanyl group （all P〈0.05）. The memory about intubation was lost in one patient in the dexmedetomidine group. Conclusion When

关 键 词：右美托咪定 气管插管 镇静 喉镜检查 

分 类 号：R614[医药卫生—麻醉学]