右美托咪定复合瑞芬太尼在烧伤困难气道患者纤维支气管镜插管中的应用效果  

Effect of dexmedetomidine combined with remifentanil in sedation and forgetting of fiberoptic bronchoscope in patients with burned difficult airways

作　　者：张宇峰[1] 周维纲[1] 杨建治 ZHANG Yufeng;ZHOU Weigang;YANG Jianzhi(Department of Anesthesiology, Hanzhong Central Hospital,Hanzhong 723000,Shanxi,China)

机构地区：[1]汉中市中心医院麻醉科

出　　处：《西部医学》2019年第7期1088-1092,共5页Medical Journal of West China

基　　金：陕西省自然科学基金面上项目(2014JM2_8157)

摘　　要：目的探讨右美托咪定复合瑞芬太尼在烧伤困难气道患者纤维支气管镜插管中应用效果。方法采用回顾性分析选取本院2015年6月~2017年6月就诊收治的烧伤困难气道行纤维支气管镜插管的68例患者的临床资料,根据麻醉用药不同将患者分为两组,每组各34例。观察组给予右美托咪定1.0ug/kg+瑞芬太尼0.5ug/kg,对照组给予丁卡因3mL。比较两组入手术室时(T0)、给药前(T1)、给药结束时(T2)、插管前(T3)、插管完成时(T4)、插管完成后5min(T5)心率、平均动脉压、呼吸频率的镇静效果及不良反应情况。结果两组给药后心率明显减慢,观察组在T2、T3、T5心率低于对照组(P<0.05);两组给药后平均动脉压明显降低,观察组T2~T5平均动脉压明显高于对照组(P<0.05);两组给药后呼吸频率降低,观察组在不同时间点呼吸频率的波动范围很小,观察组T2~T5呼吸频率高于对照组(P<0.05);观察组镇静、声带活动、咳嗽评分均低于对照组(P<0.05);观察组不良总发生率低于对照组(P<0.05)。结论对烧伤困难气道患者在纤维支气管镜插管中使用右美托咪定复合瑞芬太尼静麻药的镇静效果好,可维持稳定的血流动力学,安全性好,可在临床推广应用。Objective To investigate the effects of dextromethorphan combined with remifentanil on the circulation and respiration of bronchoscopic intubation in patients with burned difficult airways and the effects on adverse reactions. Methods A retrospective analysis of 68 patients with burned difficult airways admitted to our hospital between June 2015 and June 2017 was performed. The patients were divided into two groups according to different medications. The observation group received 1.0 ug/kg dexmedimethamine + 0.5 ug/kg remifentanil, and the control group received tetracaine 3 mL. The sedative effects of heart rate, mean arterial pressure, and respiratory rate in two groups at different times and adverse reaction condition were observed. Results The heart rates of the two groups were significantly slowed after administration. The heart rates of the observation group at T2, T3, and T5 were significantly lower than those of the control group(P<0.05). The mean arterial pressure was significantly reduced in the two groups after administration. The mean arterial pressure in the observation group was significantly higher than that in the control group at T2 to T5(P<0.05). Respiratory frequency was significantly reduced in the two groups after administration, and the fluctuation range of respiratory rate was very small in the observation group at different time points. The respiratory rate in the observation group was significantly higher than that in the control group at T2 to T5(P<0.05). The sedation, vocal cord activity, and cough scores in the observation group were lower than those in the control group(P<0.05).⑤ The overall incidence of adverse events in the observation group was significantly lower than that in the control group(41.17% vs 70.59%)(P<0.05). Conclusion The use of dextromethorphan combined with remifentanil anesthetic for bronchoscopic intubation in patients with burned difficult airways has good sedative effect. It can maintain stable hemodynamics, and has good safety.

关 键 词：右美托咪定 瑞芬太尼 烧伤困难气道 纤维支气管镜 气管插管 

分 类 号：R614.2[医药卫生—麻醉学]