摘要
目的观察右美托咪定用于困难气道患者纤维支气管镜清醒气管插管的临床效果。方法选择MallampattiⅢ～Ⅳ级择期手术的患者40例,采用随机数字表法分为2组,右美托咪定组(DEX组,20例)和咪唑安定联合芬太尼组(C组,20例)。DEX组给予右美托咪定1μg/kg,15 min输注完毕。C组给予咪唑安定1 mg、芬太尼0.1～0.15 mg。两组患者均采用1%丁卡因实施上呼吸道表面麻醉,随后纤维支气管镜引导经口气管插管。气管插管成功后立即给予镇静、镇痛及肌松药,连接麻醉机行机械通气。记录患者入室(T1)、药物输注完毕(T2)、置入纤维支气管镜前(T3)、气管插管即刻(T4)的BP、HR、SpO2、BIS及OAA/S评分。术后1 d随访,记录患者对气管插管的记忆情况。结果DEX组BP无明显变化,T2时HR明显低于T1、T4(P<0.05)。C组T3时SBP明显低于T1(P<0.05),T4时HR高于T3(P<0.05)。DEX组T2、T3时SBP高于C组(P<0.05),T2、T4时HR低于C组(P<0.05)。两组患者SpO2、BIS及OAA/S评分比较差异无统计学意义(P>0.05)。DEX组气管插管的记忆率高于C组(P<0.05)。结论清醒气管插管前静脉缓慢给予右美托咪定镇静血流动力学平稳,无呼吸抑制的风险,可以安全用于困难气道患者清醒气管插管。
Objective To evaluate the efficacy of dexmedetomidine for awake intubation in patients with potential difficult airways.Methods 40 patients with mallampatti grade of Ⅲ~Ⅳ were randomly divided into two groups：dexmedetomidine group（group D,n=20）and control group（group C,n=20）.In group D,dexmedetomidine 1 μg/kg was infused during 15 min.In group C,patients received midazolam 1 mg and fentanyl 0.05~0.1 mg.All patients were given enough topical anesthetics with 1% dicaine in upper respiratory tract.Then awake intubation with fiberoptic bronchoscope was conducted.BP,HR,SpO2,BIS and OAA/S were recorded before drug infusion（T1）,at the end of infusion（T2）,before intubation（T3）and success of intubation（T4）.Patients′ memory about intubation was recorded at the first postoperative day.Results In group D,HR was significantly lower at T2 than those at T1 and at T4（P0.05）.In group C,SBP was lower at T3 than at T1（P0.05）,and HR was higher at T4 than at T3（P0.05）.Compared with group C,SBP at T2 and T3 were significantly higher in group D（P0.05）,and HR at T2 and T4 were significantly lower（P0.05）.There was no significant difference in SpO2,BIS and OAA/S between the two groups.The rate of memory was higher in group D（P0.05）.Conclusion Dexmedetomidine provides stable hemodynamics and desirable sedation during awake intubaton in patients with potential difficult airways.
出处
《实用药物与临床》
CAS
2013年第7期569-571,共3页
Practical Pharmacy and Clinical Remedies
