右旋美托咪啶复合表麻用于保留自主呼吸的气管插管

The Dextral Dexmedetomidine Composite Anesthesia Endotracheal Intubation for Spontaneous Breathing

目的观察右旋美托咪啶复合表面麻醉用于保留呼吸的气管插管的安全性及对循环的影响。方法选择50例ASA 1～2级,拟于气管插管全身麻醉下行腹部或脊柱手术的患者,随机分为右美组(A组)和对照组(B组),每组各25例。右美组:按1μg/kg剂量,采用微量注射泵于10～15 min内注射右旋美托咪啶,分3次以2%利多卡因进行舌根、会厌部表麻;环甲膜穿刺,以2%利多卡因2～3mL气管内喷雾麻醉。对照组不予右旋美托咪啶,表麻及气管内喷雾麻醉同右美组。分别记录两组患者气管插管前、后1min、3min、5min的平均血压(MBP),心率(HR),脉搏氧饱和度(SpO2),并比较两组插管成功率。结果两组患者麻醉气管插管前的MAP、HR、SpO2相比较无明显差异(P>0.05),而在气管导管插入后1min、3min右美组MAP,HR低于对照组(P<0.05);右美组呛咳发生率明显低于对照组(25%vs 86%,P<0.05)。所有患者均能配合张口行气管插管,两组患者插管均一次成功。结论右旋美托咪啶复合表麻应用于保留自主呼吸的气管插管,可减少插管时的循环波动,可安全用于此类插管。

Objective To observe the safety and the effects of dexmedetomidine on circulation in intubation with spontaneous respiration under topical anesthesia. Methods Fifty ASA 1~2 patients underwent abdominal or spinal operations under general anesthesia were randomLy divided into 2 groups： Dexmedetomidine group （Group A） and Control group （Group B） （n=25）. Group A： Continuous infusion with dexmedetomidine （lrtg/kg） in 10~15 min, topical anesthesia using spraying with 2% Lidocaine 3 times at the sites of the root of tongue and the epiglottis. After that, the thyrocricoid punctures were performed, 2-3 mL Lidocaine （2%） were sprayed into the tracheas. The topical anesthesia and the thyrocricoid punctures were similar as Group A, except without dexmedetomidine infusion. The MBP, HR, SpO2 were recorded at the time of pre-intubation, and 1, 3, 5 min after intubation. The achievement ratio of intubation was also recorded. Results There was no different in MBP, HR, SpO2 between groups before the tracheal intubation （P〉0.05）. The MBP, HR in group A were both lower than group B after 1 and 3 min （P〈0.05）. The bucking ratio in group A was lower than group B （25% vs 86%, P〈0.05）. All the patients can open their mouths with the orders and the intubations were all succeed by one time. Conclusions Dexmedetomidine infusion combined with topical anesthesia can safely used for tracheal intubation with spontaneous respiration and can reduce the responses in circulation.