右美托咪定复合瑞芬太尼用于鼾症患者药物诱导睡眠内镜检查术的效果  

Efficacy of dexmedetomidine combined with remifentanil for drug-induced sleep endoscopy in patients with snoring

作　　者：于晖[1] 许辉杰[2] 张莹[1] 高瞻[2] 时迎斌[1] 李海[1] 赵楠楠[1] 左明章[1] Yu Hui;Xu Huijie;Zhang Ying;Gao Zhan;Shi Yingbin;Li Hai;Zhao Nannan;Zuo Mingzhang(Department of Anesthesiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Beijing 100730, Chin)

机构地区：[1]北京医院麻醉科,100730 [2]北京医院耳鼻喉科,100730

出　　处：《中华麻醉学杂志》2018年第3期308-311,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（61271410）

摘　　要：目的评价右美托咪定复合瑞芬太尼用于鼾症患者药物诱导睡眠内镜检查术的效果。方法择期拟行药物诱导睡眠内镜检查术的鼾症患者60例，性别不限，年龄18-61岁，BMI 21.0-33.1 kg/m^2，采用随机数字表法分为右美托咪定复合异丙酚组（P组）和右美托咪定复合瑞芬太尼组（R组），每组30例。2组均于10 min内静脉输注右美托咪定负荷剂量0.6 μg/kg，随后以0.6 μg·kg^－1·h^－1的速率静脉输注10 min，之后P组靶控输注异丙酚，初始效应室浓度（Ce）1.0 μg/ml，R组靶控输注瑞芬太尼，初始Ce 1.5 ng/ml，2组待效应室和血浆浓度平衡2 min后分别以0.2 μg/ml和0.2 ng/ml的梯度调整，直至患者出现满意的鼾声并能够顺利进行睡眠内镜检查术，维持P组和R组Ce不变。分别于患者入室平静5 min（T1）、输注右美托咪定20 min（T2）、异丙酚Ce 1.0 μg/ml和瑞芬太尼Ce 1.5 ng/ml平衡2 min后（T3）、检查开始时（T4）、鼻咽喉镜到达口咽部（T5）和检查结束（T6）时记录BIS值；分别于T1-4时记录患者警觉/镇静评分（OAA/S评分）。记录镇静准备时间、恢复时间、SpO2最低值及不良事件的发生情况。结果60例患者均成功完成检查。与P组比较，R组T3-6时BIS值升高，镇静准备时间延长，恢复时间缩短，SpO2最低值升高，呼吸抑制发生率降低（P〈0.05）。2组T1-4时OAA/S评分比较差异无统计学意义（P〉0.05）。结论右美托咪定复合瑞芬太尼用于鼾症患者药物诱导睡眠内镜检查术的效果优于右美托咪定复合异丙酚。Objective To evaluate the efficacy of dexmedetomidine combined with remifentanil for drug-induced sleep endoscopy （DISE） in the patients with snoring.Methods Sixty patients of both sexes with snoring, aged 18-61 yr, with body mass index of 21.0-33.1 kg/m^2, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective DISE, were randomly divided into either dexmedetomidine combined with propofol group （group P） or dexmedetomidine combined with remifentanil group （group R）, with 30 patients in each group.Dexmedetomidine was infused within 10 min in a loading dose of 0.6 μg/kg, followed by an infusion of 0.6 μg·kg^-1·h^-1 for 10 min in both groups.Then propofol was given by target-controlled infusion with the initial target effect-site concentration （Ce） of 1.0 μg/ml in group P, and remifentanil was given by target-controlled infusion with the initial target Ce of 1.5 ng/ml in group R. At 2 min after the target effect-site and plasma concentrations were balanced, the Ces of propofol and remifentanil were adjusted by increments of 0.2 μg/ml and 0.2 ng/ml, respectively, until satisfactory snoring occurred and then the Ce was maintained at this level in P and R groups.Bispectral index value was recorded at 5 min after admission to the operating room （T1）, at 20 min of dexmedetomidine infusion （T2）, at 2 min after the target effect-site and plasma concentrations were balanced （T3）, at the beginning of DISE （T4）, when the nasopharyngolarygnoscope reached the site of oropharynx （T5） and at the end of DISE （T6）. Observer′s Assessment of Alertness/Sedation scale scores were recorded at T1-4.The time for preparing sedation, recovery time, the lowest value of SpO2 and development of adverse events were recorded.Results Sixty patients completed DISE successfully.Compared with group P, the bispectral index value at T3-6 was significantly increased, the time for preparing sedation was prolonged, the recovery time was shortened, the lowest value of SpO2

关 键 词：右美托咪啶 哌啶类 打鼾 内窥镜检查 睡眠 

分 类 号：R614[医药卫生—麻醉学]