右美托咪啶复合瑞芬太尼在清醒气管插管中的应用

Combined dexmedetomidine and remifentanil for awake endotracheal intubation

目的:观察右美托咪啶复合瑞芬太尼在清醒气管插管中的应用效果。方法:择期在气管插管全麻下行腭咽成形术的患者75例,随机分为3组:芬太尼复合氟哌利多组(FD组,n=25),咪达唑仑复合瑞芬太尼组(MR组,n=25)和右美托咪啶复合瑞芬太尼组(DR组,n=25)。FD组:芬太尼2μg/kg、氟哌利多0.08mg/kg静注;MR组:咪达唑仑0.05mg/kg、瑞芬太尼1.0μg/kg(1min内注完)静注后,瑞芬太尼以0.06μg.kg-1.min-1维持至插管成功;DR组:10min内静脉输注右美托咪啶0.6μg/kg后静注瑞芬太尼1.0μg/kg(1min内注完),继以瑞芬太尼以0.06μg.kg-1.min-1维持至插管成功。3组插管前Ramsay评分均≥4分。记录入室时(T0)、置入喉镜前(T1)和气管插管即刻(T2)的平均动脉压(MAP)和心率(HR);记录插管时间、插管过程中呼吸抑制、病人耐受及术后遗忘情况。结果:与FD组比较,MR组和DR组T0时MAP和HR差异无统计学意义(P>0.05),T1～2时MAP降低,HR减慢(P<0.05),其中DR组比MR组HR降低更加明显(P<0.05)。MR组和DR组插管舒适度优于FD组(P<0.05),插管过程的遗忘情况优于FD组(P<0.05)。MR组插管过程的遗忘情况优于DR组(P<0.05),插管过程中DR组呼吸抑制少于FD组和MR组。结论:右美托咪啶复合瑞芬太尼可很好地抑制清醒气管插管的应激反应,插管过程舒适,有一定的遗忘效应,无明显的呼吸抑制。

AIM： To observe the application effects of dexmedetomidine combined with remifentanil for awake endotracheal intubation.METHODS： Seventy five patients scheduled for uvulopalatopharyngoplasty（UPPP） under general anesthesia and trachea intubation were divided into 3 groups： fentanyl combined with droperidol group（Group FD,n=25）,midazolam combined with remifentanil group（Group MR,n=25） and dexmedetomidine combined with remifentanil group（Group DR,n=25）.Group FD： intravenous injection of fentanyl with the dose of 2 μg/kg and droperidol with the dose of 0.08 mg/kg;Group MR： after intravenous injection of midazolam with the dose of 0.05 mg/kg and remifentanil with the dose of 1.0 μg/kg within 1 minute,remifentanil was given with the dose of 0.06 μg·kg-1·min-1 until the success of trachea intubation;Group DR： after intravenous injection of dexmedetomidine with the dose of 0.6 μg/kg within 10 minutes,remifentanil was given with the dose of 1.0 μg/kg by intravenous injection within 1 minute and remifentanil was given with the dose of 0.06 μg·kg-1·min-1 until the success of trachea intubation.Ramsay score were all no less than 4 before trachea intubation.Mean arterial pressure（MAP） and heart rate（HR） at the time of entrance（T0）,the time before laryngoscopy placement（T1） and the point of trachea intubation（T2） were recorded.The time of trachea intubation,respiratory depression,patients tolerance in the process of trachea intubation and postoperative forgotten were all also recorded.RESULTS：Compared with group FD,MAP and HR in group MR and group DR at the time of T0 were not significantly different（P0.05） while MAP and HR both decreased significantly between T1 and T2（P0.05）.In addition,the descend of MAP and HR in group DR were larger than those in group MR（P0.05）.Patients in group MR and group DR felt more comfortable than those in group FD（P0.05）,the number patients with postoperative forgotten was smaller than that in group FD（P0.05） and the number of patients with respiratory depression in group DR was smaller than that in group FD and group MR.CONCLUSION： Dexmedetomidine combined with remifentanil inhibits stress reaction of patients with consciousness in the process of endotracheal intubation.Patients feel comfortable in the process of endotracheal intubation and some patients have postoperative forgotten.No obvious respiratory depression occurs.