右美托咪定复合瑞芬太尼在困难气道患者经鼻清醒镇静气管插管中的应用  

The application of dexmedetomidine combined with remifentanil in patients with difficult airway intubation

作　　者：齐丽君 牛宣耀[1] 宋成凤[1] 马英华 QI Lijun;NIU Xuanyao;SONG Chengfeng;MA Yinghua(Department of Anesthesiology,the Municipal Hospital of Heze,Shandong Province,Heze 274001)

机构地区：[1]山东省菏泽市立医院麻醉科,菏泽274001

出　　处：《南通大学学报（医学版）》2021年第1期44-46,共3页Journal of Nantong University(Medical sciences)

基　　金：菏泽市立医院院级项目(2019YN31)。

摘　　要：目的:探讨右美托咪定复合瑞芬太尼在困难气道患者经鼻清醒镇静气管插管中的应用效果。方法:根据Wilson评分及气道三维重建技术选择存在可疑困难气道手术患者120例。采用随机数字表法分为两组,观察组予右美托咪定1μg/kg复合瑞芬太尼0.5μg/kg;对照组予咪达唑仑30μg/kg复合瑞芬太尼0.5μg/kg分别进行麻醉诱导。记录两组患者麻醉诱导前(T0)、插管即刻(T1)、插管后3 min(T2)时的心率(heart rate, HR)、脉搏血氧饱和度(pulse oxygen saturation, SpO_(2))、脑电双频指数(bispectral index, BIS)及气道压力(airway pressure, PAW)、呼气末二氧化碳分压(end-tidal carbon dioxide tension, P_(ET)CO_(2))等指标。术后48~72 h内记录患者经鼻气管插管中的不良回忆,采用《症状自评量表SCL-90》进行评估。结果:T1时刻,对照组HR、平均动脉压(mean arterial pressure, MAP)明显降低,T2时HR、MAP明显增高,SpO_(2)及BIS变化差异无统计学意义。观察组各时间点HR、MAP无明显变化。观察组气管插管条件评分、对气管插管的耐受性及插管舒适度均明显优于对照组。结论:右美托咪定复合瑞芬太尼可在困难气道清醒镇静经鼻气管插管中创造良好的气管插管条件并显著降低患者出现应激反应的概率,值得临床推广。Objective:To explore the e ffect of dexmedetomidine combined with remifentanil in patients with difficult airway intubation through nasal conscious sedative tube.Methods:According to Wilson′s score and 3D reconstruction technique,120 patients with suspected difficult airway operation were selected.The patients were randomly divided into two groups by case selection,clinical operation and data recording.Observation group:dexmedetomidine 1μg/kg combined with remifentanil0.5μg/kg,control group:midazolam 30μg/kg combined with remifentanil 0.5μg/kg.Anesthesia induction was carried out.Heart rate(HR),end-tidal carbon dioxide tension(SpO_(2))and bispectral index(BIS)values,airway pressure(PAW),end-tidal carbon dioxide partial pressure(P_(ET)CO_(2))were recorded before induction(T0),immediately after intubation(T1)and 3 minutes after intubation(T2).Bad recollections of intubation were followed up within 48-72 hours after operation,and SCL-90 was evaluated.Results:HR and MAP decreased significantly in the control group after induction(T1),HR and map increased significantly during intubation(T2),while SpO_(2)and BIS did not change significantly.There was no significant change in HR and MAP in the observation group.Compared with the control group,the score of tracheal intubation condition and the tolerance to tracheal intubation in the observation group were increased,and the comfort of tracheal intubation was also significantly improved.Conlusion:The application of dexmedetomidine combined with remifentanil in conscious sedation of difficult airway through nasotracheal intubation is of great clinical significance,which can create good intubation conditions and significantly reduce the probability of stress response in patients,and is worthy of clinical recommendation.

关 键 词：右美托咪定 瑞芬太尼 清醒镇静 气管插管 

分 类 号：R614.24[医药卫生—麻醉学]