不同剂量右美托咪定在清醒镇静下经鼻气管插管中的应用  

Application of different doses of dexmedetomidine in nasal tracheal intubation under conscious sedation

作　　者：夏乐强[1] 张先杰[1] 刘欣[1] 陈文亚[1] 王瑛[1] XIA Leqiang;ZHANG Xianjie;LIU Xin;CHEN Wenya;WANG Ying(Department of Anesthesiology,Deyang People's Hospital in Sichuan Province,Deyang 618000,China)

机构地区：[1]四川省德阳市人民医院麻醉科

出　　处：《中国现代医生》2019年第21期142-145,共4页China Modern Doctor

摘　　要：目的探讨不同剂量右美托咪定联合舒芬太尼在颌面外科清醒镇静经鼻气管插管中的应用。方法选择我院 2017年8月~2018年12月口腔颌面外科需经鼻气管插管的择期手术患者150例,ASAⅠ~Ⅱ级,随机分为三组,D1组(右美托咪定1 μg/kg+舒芬太尼0.01 μg/kg),D2组(右美托咪定1.5 μg/kg+舒芬太尼0.01 μg/kg)和M组(咪达唑仑2mg+舒芬太尼0.01μg/kg)。患者入室后经鼻滴入麻黄碱,以丁卡因行表面麻醉,并静脉泵入上述药物(15 min内给完)。记录入室后T0、喉镜置入时T1、气管导管置入后即刻T2,记录患者MAP、HR、SPO2;并记录插管评分(呛咳、肢体运动)、插管舒适度评分、气道梗阻评分;术后随访患者插管引起的不良反应和满意度评分。结果 T1时间点三组MAP、HR明显低于T0时刻(P<0.05);T2时间点M组MAP、HR明显高于D1、D2组(P<0.05)。M组出现插管不良反应(咳嗽、体动)的次数明显多于D1、D2组(P<0.05);而D2组出现上呼吸道梗阻及心动过缓的发生率明显多于D1组和M组(P<0.05);三组患者术后不良反应无统计学差异,但D2组整体满意度评分更高(P<0.05)。结论 1.5 μg/kg右美托咪啶复合0.01 μg/kg舒芬太尼较其他两种方案更能为经鼻气管插管提供满意的镇静效果;但1 μg/kg右美托咪啶复合0.01 μg/kg舒芬太尼组上呼吸道气道梗阻发生率更低,同时循环也稳定,是值得推广的临床用药方案。Objective To investigate the application of different doses of dexmedetomidine combined with sufentanil in transnasal endotracheal intubation under conscious sedation in maxillofacial surgery.Methods 150 patients who were given elective surgery in need of transnasal endotracheal intubation in the oral and maxillofacial surgery in our hospital from August 2017 to December 2018 were selected.They were randomLy divided into three groups,D1 group(dexmedetomidine 1 μg/kg+sufentanil 0.01 μg/kg),D2 group(dexmedetomidine 1.5 μg/kg+sufentanil 0.01 μg/kg) and M Group(midazolam 2 mg+sufentanil 0.01 μg/kg).After the patient entered the surgery room,the ephedrine was dripped through the nose.Topical anesthesia was given by tetracaine,and the above drugs were intravenously pumped(finished within 15 minutes).Patients' MAP,HR,SPO2 were recorded at T0 after entering the surgery room,T1 when the laryngoscope was placed,and T2 immediately after the tracheal tube was placed;the intubation scores (cough,limb movement),intubation comfort score,and airway obstruction score were recorded;the adverse reactions caused by intubation and satisfaction scores were followed up after surgery.Results The MAP and HR of the three groups at T1 were significantly lower than those at T0(P<0.05);at T2,the MAP and HR in the M group were significantly higher than those in the D1 group and D2 group (P<0.05).The number of adverse reactions (cough,limb movement) in the M group was significantly higher than that in the D1 group and D2 group(P<0.05);the incidence rate of upper respiratory tract obstruction and bradycardia in D2 group was significantly higher than that in D1 group and M group(P<0.05);there were no statistically significant differences in postoperative adverse reactions between the three groups,but the overall satisfaction score in the D2 group was higher(P<0.05).Conclusion 1.5 μg/kg of dexmedetomidine combined with 0.01 μg/kg sufentanil provides better sedative effect for transnasal endotracheal intubation than the other two regimens;h

关 键 词：右美托咪啶 咪达唑仑 清醒镇静 气管插管 

分 类 号：R614.2[医药卫生—麻醉学]