右美托咪定和咪唑安定复合芬太尼用于清醒经鼻盲探气管插管的比较

Comparison of the effects of dexmedetomidine and midazolam with fentanyl in patients with anticipated difficult intubation during awake blind nasal intubation

目的比较右美托咪定和咪唑安定复合芬太尼在清醒经鼻盲探气管插管中的麻醉效果,以及对呼吸和循环的影响。方法选择口腔颌面外科择期手术患者40例,美国麻醉医师协会分级为Ⅰ～Ⅱ级,预测插管困难,全身麻醉诱导选择清醒经鼻盲探气管插管。随机分为实验组和对照组。实验组静脉输注右美托咪啶;对照组静脉一次性给予咪唑安定和芬太尼。记录各组在用药前的基础值(T1)、插管开始前即刻(T2)、插管开始后10 min(T3)、插管开始后20min(T4)、插管完成后即刻(T5)时的Ramsay镇静评分值、平均动脉压(MAP)、心率(HR)、心电图(ECG)、呼吸频率(RR)和脉搏血氧饱和度(SpO2)。观测插管成功率、插管尝试次数、插管时间和并发症的发生情况。气管插管完成后对诱导效果进行评级。结果实验组插管成功率显著高于对照组(P<0.05)。实验组插管尝试次数明显低于对照组(P<0.05)。对照组中发生严重的恶心、呕吐、呛咳及术后咽喉不适的比例明显更高。对照组患者在T2时点RR较T1时点明显下降,插管中和插管后RR又显著增快;实验组患者RR和SpO2都无明显变化。与T1时点比较,对照组患者在T3、T4、T5时点MAP和HR明显增高(P<0.05)。实验组患者各时点MAP和HR无明显变化(P>0.05)。实验组Ramsay镇静评分值在插管过程中明显高于对照组(P<0.05)。结论合理剂量右美托咪定比咪唑安定复合芬太尼能更安全、更有效地应用于清醒盲探气管插管。

Objective To compare the effects of dexmedetomidine and midazolam with fentanyl with anticipated difficult intubation during awake blind nasal intubation on respiration and hemodynamics of patients. Methods Forty patients （ASA class Ⅰ to Ⅱ ） undergoing selective oral and maxillofacial surgeries with anticipated difficult intubation were enrolled in the study. The patients were randomly assigned into two equal groups. Experimental group received dexmedetomidine, control group received midazolam and fentanyl. The Ramsay sedation scores, mean artery pressure （MAP）, heart rate （HR）, respiratory rate （RR） and blood oxygen saturation of pulse （SpO2） were recorded at baseline （T1）, beginning to intubate （T2）, 10 min after beginning to intubate （T3）, 20 min after beginning to intubate （T4）, and after intubation （T5）. The operative time for intubation, intubation times, success rate of intubation, the anesthetic effects and complications were recorded. Results The success rate in the experimental group was significantly higher than that in the control group （P〈0.05）. Intubation times in the experimental group was less than that in the control group （P〈0.05）. The incidence of complications such as nausea, vomiting, cough and throat unwell in the control group was higher. Compared with the T1, RR decreased at T2 in the control group, but RR increased significantly at T4 and TS. RR and SpO2 had no significant change in the experimental group. Compared with T1, MAP and HR increased at T3, T4 and T5 in the control group（P〈0.05）. MAP and HR showed no significant variations in the experimental group （P〉0.05）. The Ramsay sedation scores in the control group were lower than those in the experimental group （P〈0.05）. Conclusion Appropriate application of dexmede- tomidine can be safer and more effective than midazolam with fentanyl for awake blind intubation.