右美托咪定联合舒芬太尼在纤维支气管镜辅助经鼻气管插管中的应用

Application of dexmedetomidine combined with sufentanil in fiberobronchoscope-assisted nasal intubation

目的探讨右美托咪定联合舒芬太尼在经鼻纤维支气管镜(FBS)辅助气管插管的应用效果。方法 90例择期全麻手术患者均分为三组,以2%利多卡因实施咽喉表面麻醉,并用1%麻黄碱收缩鼻黏膜,然后分别静脉泵入舒芬太尼2μg/kg(A组)、右美托咪啶1μg/kg(B组)和两者联合应用(C组)。三组药物均15min泵完。其后在FBS引导下经鼻气管插管。记录Koung评分、气道梗阻评分、呼吸抑制、不良事件发生情况以及血管活性药的使用情况;术后24h随访咽喉疼痛、声音嘶哑及气管插管时知晓情况。结果 C组Koung评分低于A、B组[(2.9±0.5)分vs.(4.0±0.6)分、(3.1±0.5)分](P<0.05)。C组呼吸抑制发生率低于A、B组(3.3%vs.23.3%、16.7%)(P<0.05)。C组使用美托洛尔1例(3.3%)和乌拉地尔2例(6.7%),均明显少于B组的2例(6.7%)和8例(26.7%)和A组的5例(16.7%)和7例(23.3%)(P<0.05)。C组气管插管知晓发生率10.0%(3/30),明显低于A组的40.0%(12/30)和B组的33.3%(10/30)(P<0.05)。结论联合应用舒芬太尼和右美托咪定可以有效减轻经鼻FBS辅助气管插管患者痛苦,减少插管应激反应和不良反应。

Objective To investigate the outcomes of dexrnedetomidine combined with sufentanil before fibrobronchoscope（FBS）=assisted nasal intubation. Methods A total of 90 patients undergoing operation under general anesthesia was equally assigned into three groups of A（sufentanil 2 μg/kg）,B（dexmedetomidine 1 μg/kg） and C（combined use of sufentanil and dexmedetomidine）. After throat spray with 2% lidocaine and nasal drip with 1% ephedrine, sufentanil and dexrnedetomidine were infused intravenously within 15 min. Then FBS-assisted nasal intubation was performed. Koung score, airway obstruction score, respiratory depression, adverse events and vasoactive drug use were evaluated. The patients were followed up at 24 hours after operation and sore throat,hoarseness and awareness to intubation were recorded. Results Koung score was lower in group C than that in groups of A and B[（2.9±0.5） points vs. （4. 0±0. 6） points and （3. 1±0. 5） points]（P〈0. 05）. The incidence of respiratory depression was lower in group C than that in groups of A and B（3.3% vs. 23. 3% and 16.7%） （P〈0. 05）. The percentages of metoprolol and urapidil use during intubation in group C were 3.3% and 6.7% ,which were less than 6.7% and 26.7% in group B and 16.7% and 23. 3% in group A（P〈0. 05）. The incidence of awareness to intubation was lower in group C than that in groups of A and B（10. 0% vs. 40. 0% and 33.3%） （P〈0. 05）. Conclusion Combined use of sufentanil and dexmedetomidine before FBS-assisted nasal intubation is effective in reducing stress response and making patient comfortable without severe adverse effects.