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右旋美托咪定在盲探气管插管患者中的应用
Application of Dexmedetomidine in patients receiving blind tracheal intubation

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DOI:
作者:
胡蓉 姜虹 朱也森
Hu Rong, Jiang Hong, Zhu Yesen.
作者单位:
上海交通大学医学院附属第九人民医院麻醉科
Department of Anesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University, School of Medicine
关键词:
右旋美托咪定；清醒经鼻插管；盲探气管插管装置；
Dexmedetomidine; awake nasal tracheal intubation; blind tracheal intubation
摘要:
【摘要】 目的 通过比较右旋美托咪定和咪唑安定复合芬太尼诱导下实施表面麻醉后使用盲探气管插管装置经鼻清醒气管插管的应用效果，评价右旋美托咪定在使用困难气道插管装置经鼻清醒气管插管中的临床应用价值。 方法 50例口腔颌面外科困难气道患者随机分为2组，每组25例。组I在诱导插管前15min（T0）持续静脉输注1.0μg/kg右旋美托咪定10min，组II在诱导插管前5min(T0 ）静脉推注0.02mg/kg咪唑安定及2μ/kg芬太尼。两组患者应用盲探气管装置对患者进行经鼻气管插管，观察两组插管成功率，插管所用时间，T0(T0)、T1(光索置入气道即刻)及T2（经光索引导气管导管置入气管即刻）患者警觉/镇静（OAA/S）评分，循环、呼吸功能变化及并发症情况。结果 两组插管成功率均为100%（25/25），组I平均插管时间为（3.2±0.5）min，组II平均插管时间为（3.3±0.4）min，两组间的差异无统计学意义（P＞0.05）。组I 患者T1、T2的心率（HR）显著低于组II患者（P＜0.01），组I患者T1呼吸频率（RR）显著高于组II 患者，OAA/S评分低于组II患者（P＜0.05）。结论 右旋美托咪定诱导下使用盲探气管装置经鼻清醒插管患者血流动力学更稳定，镇静程度更理想。
[Abstract] Objective To assess the clinical value of dexmedetomidine in difficult airway patients receiving awake nasal tracheal intubation with blind intubation device under topical anesthesia by comparing with combining usage of midazolum and fentanyl . Method Fifty patients with difficult airway from oral maxillofacial department were randomly divided into two groups (n=25). Patients in group I received 1.0μg/kg dexmedetomidine 15 minutes before the intubation by intravenously guttae within 10 minutes, while those in group II received 0.02mg/kgmidazolum and 2μ/kg fentanyl by intravenously injection 5 minutes before intubation. Patients in two groups all received awake nasal tracheal intubation with difficult airway device. The success rates, intubation time, OAA/S scores, the changes and complications of circulation and respiration systems at the time point of T0 (T0), T1 (immediately after inserting lightwand) and T2 (immediately after inserting the tracheal tube guided by lightwand) were observed in two groups. Results The success rates of intubation in two groups were 100% (25/25). The mean time of intubation time were （3.2±0.5）min in group I and （3.3±0.4）min in group II respectively and no significant difference was found between two groups (P＞0.05). HR at T1 and T2 in group I was significantly lower than that in group II（P＜0.01). RR at T1 in group I was higher than that in group II and the OAA/S score at T1 in group I was lower than those in group II （P＜0.05). Conclusions Patients receiving awake nasal tracheal intubation with blind tracheal device had more stable hemodynamics and more ideal sedation under the induction of dexmedetomidine.

 

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