摘要
目的比较瑞芬太尼复合丙泊酚或不同剂量右美托咪定在清醒气管插管中的安全性和有效性。方法择期全麻手术患者60例,以随机数字表法分为三组：瑞芬太尼＋丙泊酚2mg·kg^-1·h^-1组（P组）、瑞芬太尼＋0.5μg/kg右美托咪定组（D1组）和瑞芬太尼＋1μg/kg右美托咪定组（D2组）,每组20例。入室后三组患者均以0.25μg·kg^-1·min^-1泵注瑞芬太尼,同时泵注不同镇静药,给药后5min,2%利多卡因进行气管内表面麻醉,给药后10min行可视喉镜下气管插管。记录插管成功率、插管时间,并记录给药前（T0）、插管前（T1）、插管成功即刻（T2）及插管后3min（T3）时的MAP、HR、SpO2;记录T0～T2时RR及PETCO2;同时记录患者呼吸抑制、呛咳及插管知晓等不良反应。结果 P组、D1和D2组一次插管成功率分别为80%、85%和90%。与T0时比较,T1时D1、D2组HR均明显减慢（P〈0.01）,而D2组MAP明显升高（P〈0.01）;T2时P、D1组HR明显增快（P〈0.01）,三组MAP均明显升高（P〈0.01）;T3时P组MAP明显降低,且明显低于D1、D2两组（P〈0.01）。与T0时比较,T1、T2时三组患者RR均明显减慢,PETCO2明显升高（P〈0.01）,其中D1组RR明显快于,PETCO2明显低于P组和D2组（P〈0.05）。P组患者呼吸抑制、呛咳及插管知晓等不良反应的发生率明显高于D1、D2组（P〈0.05或P〈0.01）。结论瑞芬太尼复合右美托咪定可安全地用于清醒气管插管,在维持血压稳定及减少不良反应方面优于复合丙泊酚。瑞芬太尼复合小剂量右美托咪定对呼吸抑制轻微,安全性较高。
Objective To compare the safety and efficacy between remifentanil combined with propofol or different doses of dexmedetomidine（DEX）in awake intubation.Methods Sixty patients undergoing general anesthesia were randomly distributed into three groups（n=20）：remifentanil＋propofol 2mg·kg^-1·h^-1（group P）,remifentanil＋DEX 0.5μg/kg（group D1）,remifentanil＋DEX1μg/kg（group D2）.Vital signs were monitored after entering operating room and oxygen was given through facemask.All patients in the three groups received remifentanil（0.25μg·kg^-1·min^-1）combined with different kinds and doses of sedatives.After 5 mins,each patient received laryngeal and pharyngeal local anesthesia.After further 5mins,all the infusion drugs were stopped and endotracheal intubation was performed by video laryngoscopy.The intubation success rate and intubation time were noted.The MAP,HR,and SpO2 were recorded before drug administration（T0）,before intubation（T1）,on successful intubation（T2）and 3mins post-intubation（T3）.In addition,the RR and PETCO2 of T0-T2,and adverse reactions including respiratory depression,coughing during intubation,and intubation awareness were also recorded.Results The rates of successful intubation on first attempt were 80%,85% and 90% in P,D1 and D2groups respectively.For T1,the HR of groups D1 and D2were significantly slower（P〈0.01）,while the MAP of group D2 increased significantly（P〈0.01）,compared to T0.For T2,the HR of groups P and D1 were increased significantly（P〈0.01）,while the MAP of all three groups were higher than T0（P〈0.01）.For T3,the MAP of group P was significantly lower than the other two groups（P〈0.01）.Compared with T0,the RR of three groups was reduced after drug administration,while the PETCO2 was significantly increased at T1,T2（P〈0.01）,with less significance in group D1（P〈0.05）.Respiratory depression,coughing,and the incidence of adverse reactions such as intubation awareness in group P were significantly higher than those in group D1 and D2（P〈0.05）.Conclusion Remifentanil combined with DEX is effective when applied to awake tracheal intubation after pre-oxygenation.It is better in maintaining the hemodynamicstability and in reducing adverse reactions.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2015年第6期555-558,共4页
Journal of Clinical Anesthesiology
