摘要
目的比较右美托咪啶与瑞芬太尼用于纤维支气管镜引导经鼻清醒气管插管的效果。方法预期困难气道择期拟行纤维支气管镜引导经鼻清醒气管插管的外科手术患者40例，年龄18—73岁，ASA分级Ⅰ～Ⅲ级，采用随机数字表法，将其分为2组（n=20）：右美托咪啶组（D组）和瑞芬太尼组（R组）。D组先静脉注射右美托眯啶负荷量1．0μg／kg，再以0．5μg·kg^-1·h^-1的速率静脉输注；R组靶控输注瑞芬太尼，血浆靶浓度3．2ng／ml。D组负荷量注射结束、R组达血浆靶浓度时进行气管插管。气管插管期间行Ramsay镇静评分；评价气管插管条件和患者对气管插管的耐受性；记录气管插管时间、气管插管成功情况、气管插管期间心血管反应、低氧血症的发生情况；术后24h回访，记录咽喉疼痛、声音嘶哑的发生情况，记录患者对气管插管的满意度评分和对气管插管的记忆情况。结果与R组比较，D组Ramsay镇静评分升高，气管插管条件和耐受性提高，气管插管时间缩短，气管插管首次成功率升高，术后满意度评分升高，不良反应发生率降低，气管插管记忆评分降低（P〈0．05）。结论与瑞芬太尼比较，右美托咪啶用于纤维支气管镜引导清醒气管插管时能提供更好的插管条件，不良反应少，且可抑制气管插管知晓的发生。
Objective To compare the efficacy of dexmedetomidine and remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope. Methods Forty ASA Ⅰ～Ⅲ aged 18-73 patients with difficult airways undergoing awake nasotracheal intubation assisted by fiberoptic bronchoscope were randomly divided into 2 groups （n = 20 each）： dexmedetomidine group （group D） and remifentanil group （group R）. A loading dose of dexmedetomidine 1.0μg/kg was injected iv and then infused at a rate of 0.5 μg·kg^-1·h^-1 in group D. Remifentanil was target controlled-infused with target plasma concentration of 3.2 ng/ml in group R. Awake nasotracheal intubation was performed after dexmedetomidine loading dose was injected in group D and when the target plasma concentration of remifentanil was reached. Ramsay score was recorded during intubation, and intubation conditions （vocal cord movement, coughing, limb movement） and tolerance （during and after intubation） were evaluated. The intubation time, rate of successful intubation, side effects during intubation and 24 h after surgery, satisfactory score of patient with intubation and memory of intubation were recorded. Results Ramsay score, the first attempt success rates of intubation and satisfactory score of patients with intubation were significantly higher, intubation conditions and tolerance were better, intubation time was shorter, incidence of side effects and memory score of intubation were lower in group D than in group R （ P 〈 0.05）. Conclusion Dexmedetomidine provides better intubation conditions, less side effects and awareness of intubation than remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2011年第11期1306-1309,共4页
Chinese Journal of Anesthesiology
