不同剂量右美托咪定复合瑞芬太尼在纤维支气管镜引导清醒气管插管术中的应用  

Effects of different doses of dexmedetomidine combined with remifentanil in awake tracheal intubation guided by fiberoptic bronchoscope

作　　者：杨光 高逸龙 张凤 乔辉 高金贵[3] YANG Guang;GAO Yilong;ZHANG Feng(Department of Anesthesia,Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China;不详)

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京市100038 [2]郑州大学医学院临床医学系 [3]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《河北医药》2021年第14期2130-2133,共4页Hebei Medical Journal

摘　　要：目的观察不同剂量右美托咪定复合瑞芬太尼用于立体定位颅内电极植入术患者纤维支气管镜引导清醒气管插管术的改良效果。方法择期行立体定位颅内电极植入术患者30例,采用随机数字表法分为3组(n=10):低剂量右美托咪定复合瑞芬太尼组(LD组)、高剂量右美托咪定复合瑞芬太尼组(HD组)和丙泊酚复合瑞芬太尼组(P组)。LD组和HD组分别静脉输注右美托咪定0.5 g·kg^(-1)·h^(-1)和0.7 g·kg^(-1)·h^(-1);P组静脉输注丙泊酚2 mg·kg^(-1)·h^(-1)。3组同时输注瑞芬太尼0.2μg·kg^(-1)·min^(-1),10 min后给予2%利多卡因表面麻醉及环甲膜穿刺,行FOB引导清醒气管插管术。于入室后安静5 min(基础值,T0)、纤维支气管镜(FOB)置入前(T1)、气管插管成功即刻(T2)时记录患者的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_(2))。记录气管插管成功情况、气管插管时间及插管期间不良反应的发生情况。结果与T0时比较,T2时LD组和P组的HR和MAP均升高(P<0.05)。T1、T2时LD组和HD组患者的HR均低于P组,且T2时点HD组HR明显低于LD组(P<0.05)。T1、T2时LD组和HD组患者的SpO_(2)均高于P组(P<0.05)。3组患者一次气管插管成功率无统计学差异(P>0.05),与P组相比,HD组患者插管时间明显缩短(P<0.05)。P组患者呼吸抑制、呛咳的发生率明显高于LD组和HD组(P<0.05)。结论在完善气道表面麻醉的基础上,右美托咪定复合瑞芬太尼能够安全有效地用于FOB引导清醒气管插管术;与瑞芬太尼复合丙泊酚相比,具有显著的优化作用,而静脉输注瑞芬太尼0.2μg·kg^(-1)·min^(-1)复合右美托咪定0.7μg·kg^(-1)·h^(-1)在维持血流动力学方面更稳定,是较为合理的临床用药剂量。Objective To investigate the effects of different doses of dexmedetomidine combined with remifentanil in awake tracheal intubation guided by fiberoptic bronchoscope in patients with stereotactic intracranial electrode implantation.Methods A total of 30 patients who were ready to undergo stereotactic intracranial electrode implantation were enrolled in the study,who were randomly divided into three groups,with 10 cases in each group:low-dose dexmedetomidine+remifentanil group(group LD),high-dose dexmedetomidine+remifentanil group(group HD)and propofol+remifentanil group(group PD).The patients in LD group and HD group received intravenous infusion of dexmedetomidine 0.5μg·kg^(-1)·h^(-1) and 0.7μg·kg^(-1)·h^(-1),respectively,however,the patients in group PD were treated by intravenous infusion of propofol 2mg·kg^(-1)·h^(-1).And the patients in the three groups were simultaneously infused with 0.2μg·kg^(-1)·min^(-1) of remifentanil,and 10 minutes later were given 2%lidocaine surface anesthesia and cyclothyrodocaine puncture,then the fiberoptic bronchoscope guided awake tracheal intubation was performed.The MAP,HR and SpO_(2) at 5min after entering the room(baseline value,T0),before FOB implantation(T1),and immediately after successful endotracheal intubation(T2)were recorded.Moreover the success rate of endotracheal intubation,the time of endotracheal intubation and the incidence of adverse reactions during intubation were observed and compared among the three groups.Results As compared with those at T0,the HR and MAP levels in group LD and group PD at T2 were significantly increased(P<0.05).The HR levels in group LD and group HD at T1 and T2 were significantly lower than those in group PD,and the HR levels in group HD at T2 were significantly lower than those in group LD.The SpO_(2) levels in group LD and group HD at T1 and T2 were significantly higher than those in group PD(P<0.05).There was no significant difference in success rate of the first endotracheal intubation among the three groups(P>0.05),but

关 键 词：清醒气管插管术 右美托咪定 瑞芬太尼 丙泊酚 麻醉 

分 类 号：R976.2[医药卫生—药品]