右美托咪啶复合芬太尼对清醒经鼻气管插管的镇静效果  

Evalution of the combination of dexmedetomidine and fentanyl in sedation during awake nasotracheal intubation

作　　者：彭盛亮 黄丹[1] 肖凡[1] 卢俊[1] 周斌[1] 胡海军 徐国海[1] 罗振中[1] PENG Shengliang, HUANG Dan, XIAO Fan, LU Jun, ZHOU Bin, HU Haijun, XU Guohai, LUO Zhenzhong.(Department of Anesthesiology, The Second Affiliated Hospital of Nanchang Uaiversity, Nanchang 330006, Chin)

机构地区：[1]南昌大学第二附属医院麻醉科,南昌330006

出　　处：《实用医学杂志》2018年第12期2061-2064,2069,共5页The Journal of Practical Medicine

摘　　要：目的观察右美托咪啶复合芬太尼对纤支镜引导下清醒经鼻气管插管的镇静效果。方法择期行经鼻气管插管全麻口腔颌面部手术患者120例,ASAⅠ~Ⅱ级,将患者随机分为右美托咪啶1μg/kg(L组);右美托咪啶2μg/kg(H组);右美托咪啶1μg/kg+芬太尼1μg/Kg(DF组)。插管前三组患者分别按照上述剂量缓慢静脉泵注相应的药物(15 min内泵注完毕),完善表面麻醉后行纤支镜引导下经鼻气管插管。记录入室安静5 min(基础值,T0)、纤支镜置入前(T1)、插管后即刻(T2)时心率、平均动脉压;并记录插管评分(声带闭合情况、呛咳、肢体运动)、纤支镜插管舒适度评分、经鼻气管插管后评分和气道阻力评分;术后随访患者对插管过程中的记忆水平、不良反应和满意度评分。结果 T1时三组MAP、HR明显低于T0时(P<0.05);T2时L组MAP、HR明显高于H、DF组(P<0.05)。L组出现声带闭合、重度咳嗽、中度至重度肢体运动的次数明显多于H、DF组。L组出现重度痛苦表情和插管后反抗的次数明显多于H、DF组。H组出现气道梗阻及心动过缓的次数明显多于L、DF组。L组患者关于麻醉前准备、局部麻醉和插管的记忆明显多于H、DF组,且L组患者术后满意度评分更低。结论 1μg/kg右美托咪啶复合1μg/kg芬太尼与2μg/kg右美托咪啶都能为清醒纤支镜经鼻气管插管提供满意的镇静作用,但1μg/kg右美托咪啶复合1μg/kg芬太尼的气道梗阻发生率低,是较为合理的临床用药方案。Objective To evalute the combination of dexmedetomidine and fentanyl in sedation duringawake nasotracheal fiberoptic intubation. Methods One hundred and twenty ASAⅠ or Ⅱ patients scheduled toreceive general anesthesia were randomly divided into 3 groups（n = 40 in each group）. Patients in group Lreceived an infusion of 1 μg/kg dexmedetomidine,patients in group H received an infusion of 2 μg/kg dexmedeto-midine,and patients in group DF received an infusion of 1 μg/kg dexmedetomidine added to 1 μg/kg fentanyl.Nasotracheal intubation was performed after complete topical anesthesia. HR and MAP were recorded before anes-thesia（baseline,T0）,before intubation（T1）and immediately after intubation（T2）,respectively. The intubationscore（vocal cord movement,coughing and limb movement）,fiberoptic intubation score,nasotracheal intubationscore and airway obstraction score were assessed in all aptients. On the first post-operative day,recall,adverseevents and satisfaction score were also assessed. Results HR and MAP at T1 in three groups were significantlylower than those at T0（P〈0.05,respectively）. HR and MAP at T2 in group L were significantly higher thanthose in group H and DF（P〈0.05,respectively）. More incidence of vocal cord closed,severe cough,severe limbmovement,heavy grimacing,defensive movement of head and hands after nasotracheal intubation were observed ingroup L than those in the other two groups. The incidence of airway obstraction and bradycardia in group H werehigher than those in group L and DF. Patients in group L had lower postoperative satisfaction scores. Conclusion Adding 1 μg/kg fentanyl to 1 μg/kg dexmedetomidine is a good method for awake nasotracheal fiberoptic intuba-tion,which can prevent the risk of airway obstruction associated with the increase of dexmedetomidine dose,withthe achievement of the same favorable sedation.

关 键 词：右美托咪啶 芬太尼 清醒经鼻纤维支气管镜插管 

分 类 号：R614[医药卫生—麻醉学]