不同负荷剂量右旋美托咪定对成人行清醒气管插管的影响

Effect of different loading doses of dexmedetomidine on sedation during awake intubation in adults

目的评价不同负荷剂量右旋美托咪定对成人行清醒气管插管的影响。方法择期全身麻醉下手术患者80例,根据右旋美托咪定剂量随机分为右旋美托咪定0.5μg/kg组(B组)、1.0μg/kg组(C组)、2.0μg/kg组(D组)和静脉滴注生理盐水对照组(A组)各20例。记录4组入手术室后10min、气管插管前、后即刻平均动脉压、心率、血氧饱和度、呼气末二氧化碳分压和脑电双频谱指数值,记录阿托品、麻黄素和乌拉地尔使用情况,观察气管插管过程中不良反应发生情况。结果 D组呼吸抑制发生率及血管活性药物使用率高于A、B、C组(P<0.05);气管插管前即刻A组脑电双频指数值高于B、C、D组(P<0.05),B、C组高于D组(P<0.05);气管插管前即刻C、D组平均动脉压和心率较入室后10min降低(P<0.05),且D组低于C组(P<0.05);气管插管后即刻A、B组平均动脉压及心率较气管插管前即刻升高(P<0.05),且高于C、D组(P<0.05)。结论右美托咪定1.0μg/kg负荷剂量用于成人清醒气管插管安全有效。

Objective To observe the effect of different loading doses of dexmedetomidine on sedation during awake intubation in adults. Methods Eighty patients undergoing elective surgery were randomly divided into group A（control group）, group B（0.5 μg/kg dexmedetomidine）, group C（ 1.0 μg/kg dexmedetomidine） and group D（2.0 μg/kg dexmedetomidine）, with 20 patients in each group. Group A was infused normal saline, and groups B, C and D were infused dexmedetomidine at loading doses of 0. 5, 1. 0 and 2. 0 μg/kg for 10 minutes respectively. Mean arterial pressure, heart rate, arterial oxygen saturation, end-tidal pressure of carbon dioxide and bispectral index were recorded 10 minutes after the patients＇ entering into the operating room, before trachea intubation and immediately after trachea intubation. The usage of atropine, atropine and Urapidil were recorded, and the adverse reaction was observed in the course of trachea intubation. Results The incidence rate of respiratory depression and the usage of vasoactive agents in group D were higher than those in the other three groups（P〈0.05）. The bispectral index at the time immediately before intubation was higher in group A than that in group B, C and D（P（0.05）, and higher in group B and group C than that in group D（P〈0.05）. The mean arterial pressure and heart rate declined in group C and group D before intubation compared with those 10 minutes after the patients＇ entering into the operating room （P〈0.05）, and were lower in group D than those in group C（P〈0.05）. The mean arterial pressure and heart rate were higher in group A and group B after intubation than those before intubation（P〈 0.05）, and also higher than those in group C and group D（P〈0.05）. Conclusion Dexmedetomidine could be safely and effectively used for the sedation during awake intubation in adults, and therecommended loading dose is 1 μg/kg.