地佐辛联合不同剂量右美托咪定用于OSAHS患者经鼻清醒插管的效果比较  

Effects of dezocine combined with different loading dose of dexmedetomidine on awake fiberoptic nasotracheal intubation in patients with obstructive sleep apnea-hypopnea syndrome

作　　者：崔松勤[1] 黄红芳[1] 黄雪莲[1] 芮骁 黄赛赛[1] CUI Songqin;HUANG Hongfang;HUANG Xuelian;RUI Xiao;HUANG Saisai(Department of Anesthesiology,the Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学附属医院麻醉科,226000

出　　处：《天津医药》2022年第7期775-779,共5页Tianjin Medical Journal

摘　　要：目的观察地佐辛联合不同剂量右美托咪啶用于阻塞性睡眠呼吸低通气暂停综合征(OSAHS)患者行纤维支气管镜引导经鼻清醒气管插管(AFNI)的效果。方法OSAHS患者80例按随机数字表法分为地佐辛0.1 mg/kg组(C组)、地佐辛0.1 mg/kg+右美托咪定(DEX)0.5μg/kg组(D1组),地佐辛0.1 mg/kg+DEX 1μg/kg组(D2组),地佐辛0.1 mg/kg+DEX 1.5μg/kg组(D3组),每组20例。在给予全部患者静脉注射地佐辛0.1 mg/kg的同时,C组静脉泵注0.5μg/kg生理盐水,D1、D2、D3组分别静脉泵注DEX 0.5、1、1.5μg/kg(10 min泵完)。气管插管前5 min行鼻腔咽喉表面麻醉,药泵注结束行AFNI。比较4组入室时(T_(0))、插管前(T_(1))和插管后(T_(2))心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO_(2))、脑电双频指数(BIS)值和Ramsay镇静评分、插管耐受度、插管时间、患者对插管的满意度、气道阻塞评分及不良反应(心动过缓、呼吸抑制、躁动、对插管有记忆)的发生率。结果时间和干预方式对HR、MAP、BIS值及Ramsay镇静评分有交互作用(P<0.05),对SPO_(2)无交互作用(P>0.05),只有时间因素影响SPO_(2)(P<0.05)。组间多重比较显示,D2组在T_(1)、T_(2)时点HR、MAP较C组降低,在T_(2)时点较D1组降低(P<0.05);D3组较C组、D1组在T_(1)、T_(2)时点HR、MAP降低;D3组心动过缓发生率较C组升高(P<0.05);与C组、D1组比较,D2、D3组在T_(1)、T_(2)时点的BIS值降低、Ramsay镇静评分升高,躁动和对插管有记忆的发生率降低,气管插管耐受度增强,气管插管时间缩短,插管满意度高(P<0.05)。结论地佐辛联合DEX可有效安全地用于OSAHS患者的AFNI,且以地佐辛0.1 mg/kg联合DEX 1μg/kg时,既能维持患者血流动力学稳定又能减少不良反应发生率。Objective To observe the efficacy of dezocine combined with different loading dose of dexmedetomidine on awake fiberoptic nasotracheal intubation(AFNI)guided by fiberoptic bronchoscopy in patients with obstructive sleep apneahypopnea syndrome(OSAHS).Methods Eighty patients with OSAHS were randomly assigned into 4 groups:the dezocine group(group C),the dezocine 0.1 mg/kg combined with DEX 0.5μg/kg group(group D1),the dezocine 0.1 mg/kg combined with DEX 1μg/kg group(group D2)and the dezocine 0.1 mg/kg combined with DEX 1.5μg/kg group(group D3),20 cases in each group.All patients were given 0.1 mg/kg of dezocine intravenously.The same amount of normal saline was intravenously pumped in group C,and DEXwas infused over 10 min by micro-injection pump(group D1:0.5μg/kg,group D2:1μg/kg,group D3:1.5μg/kg)before intubation respectively.DEX 0.5,1 and 1.5μg/kg were intravenously pumped in group D1,group D2 and group D3,respectively.Naso-pharyngeal and laryngeal mucous membrane were sprayed with 2%lidocaine for topical anesthesia 5 min before intubation in the four groups.AFNI was performed after the end of administration in the four groups.The heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SPO_(2)),the value of BIS and Ramsay sedation score at entering the OR(T_(0)),the end of administration(T_(1))and after intubation(T_(2))were observed between the four groups.Intubation tolerance,intubation time,patient satisfaction,airway obstruction score and incidence of adverse reactions(bradycardia,respiratory depression,agitation,memory of intubation)were also compared between the four groups.Results Repeated-measures ANOVA showed that there were interaction between time factor and different intervenient measures on HR,MAP,BIS value and Ramsay sedation score during the experiment(P<0.05),while there was no interaction with SPO_(2)(P>0.05),only time factor affected SPO_(2)(P<0.05).Further comparison between the four groups showed that HR and MAP were lower at T_(1) and T_(2) in the group D2than those of the group

关 键 词：右美托咪啶 睡眠呼吸暂停 阻塞性 插管法 气管内 纤维支气管镜 清醒气管插管 地佐辛 

分 类 号：R614.2[医药卫生—麻醉学]