右美托咪定靶控输注在清醒状态下纤维支气管镜经鼻气管插管的应用

Application of dexmedetomidine target-controlled infusion for sedation during awake fibreoptic nasotracheal intubation

目的探讨靶控输注右美托咪定(DEX)在纤维支气管镜引导下清醒经鼻气管插管(ANFOI)的效果。方法选择需行全身麻醉的困难气道患者40例,充分行气道表面麻醉后,随机分为2组,每组20例。D组,靶控输注1μg/kgDEX,10min注完;R组静脉注射0.05mg/kg咪唑安定后,静脉泵注瑞芬太尼0.15μg(/kg·min),总量达1.5μg/kg后,经鼻置入纤维支气管镜引导插管。记录麻醉前(T0)、注药10min后(T1)、插入气管导管后即刻(T2)的MAP、HR及SPO2,插管时的一般情况,术后随访患者对满意度进行评分。结果两组MAP和SPO2在T1、T2时点差异无显著性(P>0.05),而HR相比差异有显著性(P<0.05)。两组组内HR在T1与T0相比明显下降(P<0.05);MAP及SPO2在T2与T0及T1时点相比差异无显著性(P>0.05),HR则均有明显上升(P<0.05)。所有患者均插管成功,R组术中呼吸抑制发生率较D组高(P<0.05)。两组患者术后满意度差异无显著性(P>0.05)。结论靶控输注1μg/kg右美托咪定能减少经鼻清醒气管插管时的心血管应激反应且对呼吸无抑制作用,可安全用于ANFOI。

【Objective】To investigate the efficacy of dexmedetomidine controlled infusion for awake fibreoptic nasotracheal intubation. 【Methods】 Forty patients with anticipated difficult airways and underwent tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group （1.0 μg/kg over 10 min） （n=20） or remifentanil group （after intravenous injection of midazolam 0.05 mg/kg then controlled infusion of remifentanil 1.5μg/kg target controlled infusion, n =20）. 【Results】Compared with R group, MAP and SPO2 in D group had no significantly differences at T1, T2 （P0.05）. Compared with T0, HR at T1 obviously decreased in both groups （P0.05）, there were no significantly differences of MAP at T0, T1 and T2, then compared with T0 and T1, HR at T2 obviously increased. Intubation was successful in all patients. The incidence of respiratory inhibition was lower in the D group compared with R group （P0.05）, patient satisfaction did not differ significantly between the two groups. 【Conclusions】Controlled infusion of dexmedetomidine over 10 min decreases heart rate response to intubation without respiratory inhibition, which provides a safe and good intubation condition for awake fibreoptic nasotracheal intubation.