不同剂量右美托咪啶复合舒芬太尼用于清醒气管插管的比较

Comparison among different dosages of dexmedetomidine combined with sufentanil for tracheal intubation in awake patients

目的观察比较不同剂量右美托咪啶（dexmedetomidine，DEX）复合舒芬太尼麻醉诱导用于清醒气管插管的效果。方法选择Mallampati试验Ⅲ～Ⅳ级患者90例，采用区组随机化法分为3组（每组30例）。DEX泵注：Ⅰ组0．8μg／kg，Ⅱ组1．0μg／kg，Ⅲ组1．2μg／kg；均静脉推注舒芬太尼0．1μg／kg。观察并记录入室（T0）、插管前（T1）、插入导管即刻（T2）时的平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR）、血氧饱和度（oxygen saturation，Sp02）、血浆皮质醇浓度；记录患者插管前镇静（ramsay）评分及插管反应，并术后随访患者。结果与T0时（78±10）次，min比较，HRT。时Ⅱ组（68±9）次／min减慢（19〈0．05）；Ⅲ组T1（68±17）次／min、T2时（64±6）次／min均减慢（P〈0．05）。与Ⅰ组（81±12）次／min比较，HRT。时Ⅱ组（68±9）次/min、Ⅲ组（68±17）次／min有所减慢（P〈0．05），T2时Ⅲ组（64±6）次／min降低明显（P〈0．01）。MAPⅡ组Tl（102±19）BITIHg（1mmHg=0．133kPa）、T2（109±24）mmHg时、Ⅲ组T1（104±15）mmHg、R（111±9）mmHg时均有所升高（P〈0．05）；Ramsay评分，Ⅱ组、Ⅲ组患者都在4分～5分，结论DEX1．0μg／kg复合0．1μg／kg舒芬太尼用于清醒气管插管时效果最好，并发症也较少。

Objective to compare the effect of different dosages of dexmedetomidine （DEX） combined with sufentanil for tracheal intubation in awake patients. Methods Ninety patients with Mallampati test III-IV were randomly assigned into three groups （n=30）. Group I received intravenously pumping DEX 0.8μg/kg plus sufentanil 0.1 μg/kg, group Ⅱ with DEX 1.0 μg/kg plus sufentanil 0.1 μg/kg, group Ⅲwith DEX 1.2 μg/kg plus sufentanil 0.1μg/kg. mean arterial pressure （MAP）, heart rate（HR）, oxygen saturation （SpO2） of patients were recorded at the time points of entering the operationroom （T0）, before intubation （%） and intubation （T2）, respectively. Serial blood samples were obtained for analysis of plasma cortisol concentrations at each time points. The responses at the intubation, and Ramsay scores before intubation were recored. Memory of intubation was inquired after operation. Results HR in patients of group Ⅱ at T1（68±9） beats/min were significandy decreased compared with that at T0（78±10） beats/rain （P〈0.05）, HR in patients of group Ⅲ at T1 （68±17） beats/rain and T2 （64＋6） beats/rain are significantly decreased compared with that at T0（81±12） beats/min（P〈0.05）. HR in patients of group Ⅱ （68±9） beats/rain and Ⅲ （68±17） beats/rain at T1 are signifieandy decreased compared with that of group Ⅰ （81±12） beats/min（P〈0.05） and HR in patients of group Ⅲ at T2（64±6） beatshnin are significantly decreased compared with that of group Ⅰ （85±15） beats/min （P〈0.O1）. MAP in patients of group Ⅱ at T2（111±9） mm Hg （1 mm Hg=0.133 kPa） are significantly increased compared with that at T0（98±10） mm Hg（P〈O.05 ）. MAP in patients of group Ⅱ and Ⅲ at T1 and T2 are significantly increased compared with that of group I （P〈0.05）. Ramsay score in patients of group Ⅱ and Ⅲ at the moment of intubation are significantly higher than that in patients of group Ⅰ （P〈0.05）. Conclusions These results show that it is optimal for 1.0 μg/kg DEX combined 0.1 μg/kg sufentanil used for awake intubation.