舒芬太尼与瑞芬太尼复合右美托咪定应用于清醒经鼻气管内插管的临床效果研究  

Study of efficacy of Suphentanil and Remifentanil combined with Dexmedetomidine for awake nasotracheal intubation

作　　者：姜彦羽 张月英 JIANG Yanyu;ZHANG Yueying(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221002

出　　处：《中国校医》2024年第12期929-932,955,共5页Chinese Journal of School Doctor

摘　　要：目的 探讨舒芬太尼与瑞芬太尼复合右美托咪定清醒麻醉在纤维支气管镜引导的经鼻气管内插管过程中的临床效果。方法 选择在徐州医科大学附属医院接受口腔手术,因困难气道需要清醒气管插管患者40例,采用随机对照研究中的区组随机法将患者分为瑞芬右美托咪定组(RD组)(n=20)和舒芬右美托咪定组(SD组)(n=20)。2组患者均泵注0.1μg·kg^(-1)·min^(-1)。右美托咪定持续5 min,并维持0.5 ug·kg^(-1)·h^(-1)至插管成功。瑞芬右美托咪定组(RD组),给予瑞芬太尼0.75μg·kg^(-1)·min^(-1)(持续3 min),以0.075μg·kg^(-1)·min^(-1)维持至插管成功。舒芬右美托咪定组(SD组),泵注舒芬太尼0.2μg·kg^(-1)(持续3 min),泵注生理盐水维持至插管成功。记录进入手术室时(基础值T_(0))、插管前(T_(1))、导管过鼻咽时(T_(2))、导管套囊充气时(T_(3))、导管进入气管后2 min(T_(4))的血氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP);记录插管时间、插管一次成功率以及插管后患者的耐受性。结果 T_(1)~T_(3)时RD组的SpO_(2)与SD组比较,2组间差异有统计学意义(P<0.05)。RD组内T_(1)~T_(3)时的SpO_(2)与T_(0)时比较,差异有统计学意义(F=17.10,P<0.001)。SD组内T_(1)~T_(3)时的SpO_(2)与T_(0)时比较,差异有统计学意义(F=7.44,P<0.001)。T_(2)~T_(4)时RD组的HR与SD组比较,2组间差异有统计学意义(P<0.01)。RD组内T_(2)~T_(3)时的HR与T_(0)时比较,差异有统计学意义(F=53.92,P<0.001)。SD组内T_(2)~T_(3)时的HR与T_(0)时比较,差异有统计学意义(F=4.93,P=0.010)。T_(2)~T_(3)时RD组的MAP与SD组比较,2组间差异有统计学意义(P<0.01)。RD组内T_(2)~T_(3)时的MAP与T_(0)时比较,差异有统计学意义(F=40.80,P<0.001)。SD组内T_(2)~T_(3)时的MAP与T_(0)时比较,差异有统计学意义(F=9.34,P<0.001)。RD组的呛咳发生率与SD组比较,差异有统计学意义(P<0.05)。RD组的体动发生率与SD组比较,差异有统计学意义(P<0.05)。结论舒�Objective To investigate the clinical efficacy of Sufentanil and Remifentanil combined with Dexmedetomidine under awake anesthesia during bronchoscope-guided nasotracheal intubation.Methods A total of 40 patients who were to undergo oral surgery and required awake nasotracheal intubation due to difficult airway in the Affiliated Hospital of Xuzhou Medical University were enrolled.The patients were randomly divided into the RD group(n=20)and the SD group(n=20),with the same infusion of 0.1μg·kg^(-1)·min^(-1) by pump.Dexmedetomidine was continuously administered for 5 minutes at a rate of 0.5μg·kg^(-1)·h^(-1) until successful intubation.In the RD group,Remifentanil was given 0.75μg·kg^(-1)·min^(-1)(for 3 min)and maintained at 0.075μg·kg^(-1)·min^(-1) until successful intubation.In the SD group,Sufentanil was given 0.2μg·kg^(-1)(for 3 min)until successful intubation.Peripheral capillary oxygen saturation(SpO_(2)),heart rate(HR),mean arterial pressure(MAP),the time of entering the pure operating room(basic value T_(0)),before intubation(T_(1)),when the catheter passes through the nasopharynx(T_(2)),when the catheter cuff is inflated(T_(3)),and 2 minutes after the catheter enters the trachea(T_(4)),the intubation time,first-time success rate of intubation,and patient tolerance after intubation were recorded.Results In the RD group,the SpO_(2) levels showed significant differencefrom those of the SD group(P<0.05).Within the RD group,the SpO_(2) levels at T_(1)-T_(3) were significantly different from those at T_(0)(F=17.10,P<0.0001),while the SpO_(2) levels in the SD group at T_(1)-T_(3) were significantly different from those at T_(0)(F=7.436,P=0.0002).From T_(2)-T_(4),the HR of the RD group was also significantly different from that of the SD group(P<0.01).Within the RD group,the HR at T_(2)-T_(3) was significantly different from that at T_(0)(F=53.92,P<0.0001).The HR in the SD group at T_(2)-T_(3) was significantly different from that at T_(0)(F=4.93,P=0.01).The MAP of the RD group at T_(2)-T_(3) was si

关 键 词：舒芬太尼 瑞芬太尼 右美托咪定 清醒经鼻气管插管 安全性 

分 类 号：R826.24[医药卫生—临床医学]