右美托咪定用于Shikani喉镜引导颈椎手术清醒气管插管的研究

Application of dexmedetomidine for awake tracheal intubation with Shikani optical stylet in patients receiving cervical vertebral surgery

目的比较右美托咪定（dexmedetomide，Dex）与咪达唑仑慢诱导用于Shikani喉镜引导清醒气管插管的临床效果，探讨Dex在颈椎手术患者中的应用价值。方法30例美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级择期颈椎手术气管插管全麻手术患者，按随机数字表法均分为Dex慢诱导气管插管组（D组）和咪达唑仑慢诱导气管插管组（M组）。D组10min内静脉泵入Dex负荷量1μg／kg，继以1μg·kg^-1·h^-1维持；M组静脉注射咪达唑仑0．08ms／ks，分次追加0．02mg／kg；所有患者用2％利多卡因行咽喉腔及气管内表麻后，在适宜镇静深度下采用Shikani喉镜经口引导清醒气管插管。评估气管插管条件和患者对气管插管的耐受性及配合程度；记录气管插管次数、时间以及包括心血管反应、呼吸抑制等副作用发生情况；术后24h随访了解患者有无咽喉疼痛不适及对气管插管过程的记忆隋况。结果两组患者的插管次数及插管时间比较差异均无统计学意义（P〉0．05）。与M组比较，D组的肢体运动减少（9／3／2／1vs14/1/0/0）、插管舒适度提高（1／2／6／6vs0／0／4／11）、插管配合更佳（7/6/2vs13/2/0），并且显著改善插管心血管反应（4／15vs0／15），差异均有统计学意义（P〈0．05）。M组有3例（20％）呼吸抑制。M组2例和D组1例对插管有模糊记忆。结论Dex慢诱导较咪达唑仑更能为Shikani喉镜气管插管提供良好的插管条件、舒适性更强、副作用更少，为颈椎手术患者提供一种较理想的静脉辅助用药。

Objective To compare the clinical efficacy of dexmedetomidine （Dex） with Midazolam for awake tracheal intubation with Shikani optical stylet in patients undergoing cervical vertebral surgery, and evaluate the clinical value of Dex. Methods Thirty ASA Ⅰ -Ⅱ patients undergoing cervical vertebral surgery and slow induction of anesthesia were randomly assigned to Dex group （group D, n=15） and Midazolam group （group M, n=15）. The group D received a loading dose of 1 1μg/kg Dex intravenously over 10 min, and followed by continuous infusion at a rate of 1 1μg·kg^-1·h^-1 in group D; Group M received 0.08 mg/kg Midazolam intravenously and followed by 0.02 mg/kg intermittent bolus until the desired depth of sedation was reached. After the topical upper airway anaesthesia with 150 mg of 2% lidocaine, awake orotracheal intubation was performed using Shikani optical stylet. The intubation conditions （coughing, limb movement）, the tolerance to intubation and the level of cooperation of the patient were evaluated. The time of intubation, the frequency of intubation, adverse effects or complications such as hemodynamic change, injury in pharyngo-oral cavity, respiratory depression were observed. The incidence and severity of sore throat and memory of intubation were recorded at 24 h after surgery. Results There was no difference between group in the time required for intubation and the frequency of successful intubation （P〉0.05）. Compared to group M, the extremities s movement, the tolerance to intubation, the level of cooperation and hemodynamic changes of the patients in group D were better （P〈0.05）. The respiratory depression was observed in three cases in group M. There were two cases in the group M and one case in the group D who have vague memory of intubation at 24 h after surgery. Conclusions Slow induction of Dex is more desirable than Midazolam for intravenous sedation, for it provides favorable conditions and tolerance, few side effects for awake orotracheal intubation with Shikani optical stylet in patients undergoing cervical vertebral surgery.