不同剂量右美托咪定复合靶控瑞芬太尼用于成人清醒插管的效果

To observe effect of different loading doses of dexmedetomidine combined with target-control infusion remifentanil during awake intubation

目的观察不同剂量右美托咪定复合靶控瑞芬太尼用于清醒插管的效果。方法择期全麻手术患者40例,按照美国麻醉医师协会(ASA)分级为Ⅰ-Ⅱ级,采用随机数字表法,将患者分为右美托咪定0.25μg.kg-1.h-1(D1组)、0.5μg.kg-1.h-1(D2组)、1.0μg.kg-1.h-1(D3组)和对照组(C组)每组10例。所有患者入室后均给予1﹪丁卡因行口腔,舌根表面麻醉,D1、D2和D3组分别给予右美托咪定1.0μg.kg-1.h-1恒速泵入10min,随后分别以0.25μg.kg-1.h-1、0.5μg.kg-1.h-1、1.0μg.kg-1.h-1持续泵入,同时靶控血浆靶浓度瑞芬太尼3.0ng/ml。C组给予生理盐水泵入10min,同时靶控浆靶浓度瑞芬太尼3ng/ml。待患者意识消失对言语指令无反应后,行气管插管。记录麻醉前(T0)、插管前即刻(T1)、插管完成后1min(T2)、插管完成后5min(T3)的SBP、DBP、HR、SpO2;记录插管过程中有无恶心、呛咳、躁动等插管反应。结果四组患者均顺利完成保留自主呼吸下气管插管,与T0比较,T1时四组SBP、DBP、HR均明显降低(P<0.05);C组T2、T3时SBP、DBP均明显升高(P<0.05),HR明显增快(P<0.05);D1、D2和D3组T2、T3时心率加快但不显著,与T0比较(P>0.05),与C组比较(P<0.05);D3组T1时心率明显低于D1、D2组(P<0.05);D1和C组T2、T3时SBP、DBP均明显高于T1且高于D2、D3组(P<0.05);D3组心动过缓及呼吸抑制发生率明显高于D1、D2组(P<0.05)。结论右美托咪定复合靶控瑞芬太尼可有效安全的用于保留自主呼吸清醒插管,其中以右美托咪定0.5μg.kg-1.h-1复合靶控瑞芬太尼血流动力学更稳定且有效的减少不良反应的发生率。

Objective To observe the effect of different loading doses of dexmedetomidine combined with target-con tral infusion remifentanil during awake intubation. Methods Fourty patients to receive general anesthesia and ASA I - I] were randomly divided into four groups ： group D1 ,group D2,group D3 ,dexmedetomidine was given by pumped at continuous rate of 0.25 μg. kg -1.h 1,0.5 μg. kg-1.h-l,1.0 μg. kg- 1.h -1 and control group （group C）. The pa tients in group D1,D2 andD3 received aloading dose of dexmedetomidine（1.0 μg. kg -1. h- 1）infused over 10rain, then pumped at continuous rate of 0.25μg. kg-1. h-1 ,0.5 μg. kg -1. h -1,1.0μg. kg- 1. h-1. physiological saline was given in group C. Systolic blood pressure, Diastolic blood pressure, heart rates and arterial oxygen saturation at different time points of preanesthesia（T0 ）, intubating（T1 ）, 1 rain after intubation（T0 ）, 5 min after intubation （T3） were recorded. Nausea ,bucking,restlessness and other side-effects were observed,Results All the patients in four groups were performed successfully. SBP,DBP,and HR were significantly decreased at T1 in four group（P〈0.05） ; SBP,DBP and HR were increased in group C at T2 and T3 （P〈0.05）. The heart rates were increased in group D1 ,D2 and D3 at T2 and T3 , Compare with the time of To （P〈0.05） ,Compare with group C（P〈0.05） ; The heart rates were decreased in group D3 Compare with group D1 and D2 at T1 ;SBP,DBP were significantly increased in group DI and C Compare with the time of T1 （P〈0.05） ,Compare with group D2 and D3 （P〈0.05）. The rate of bradycardia and respiratory depression in group D3 were obviously higher than groupD2 and D3. Conclusion Dexmedetomidine combined with target contral infusion remifentanil could be safely and effectively used during awake intubation ,exmedetomidine 0.5 μg. kg- 1. h -1 combined with target-contral infusion remifentanil is the optimal dose for awake intubation which can reduce incidence rate of adverse reaction.