地佐辛联合表面麻醉用于急诊饱胃患者清醒气管插管的临床观察

Clinical observation on Dezocine with surface anesthesia in awake intubation

目的探讨地佐辛联合表面麻醉用于急诊饱胃患者清醒气管插管的效果。方法将ASAⅠ、Ⅱ级40例需行清醒气管插管的患者随机分为两组,每组20例。A组患者入室后给予0.15 mg/kg的1 mg/mL地佐辛静注,B组患者静脉给生理盐水0.15 mL/kg,5 min后两组分别行口咽喉腔表面麻醉及环甲膜穿刺气管内表面麻醉,再行清醒气管插管,记录进入手术室时(T1)、环甲膜穿刺气管内表面麻醉时(T2)、插管中(T3)、插管后(T4)的平均动脉压(MAP)、心率(HR)。记录从表面麻醉到气管内插管成功的诱导时间。统计并分析T2、T3时点患者躁动、恶心、呛咳的发生率。结果两组患者一般情况无明显差异,在T2、T3、T4时点,B组患者MAP明显高于A组,B组HR也明显快于A组,差异有统计学意义(P<0.05);B组诱导时间[(8.7±2.7)min]明显长于A组[(5.3±1.2)min],B组各时点的体动评分[T2:(1.2±0.7)分、T3:(1.8±0.5)分]均高于A组[T2:(0.4±0.3)分、T3:(0.6±0.4)分],B组恶心、呛咳发生率(85%)高于A组(30%),两组比较差异有统计学意义(P<0.05),B组有3例患者无法耐受放弃清醒插管,改用快速诱导全麻插管。结论地佐辛联合表面麻醉用于饱胃清醒气管插管,可一定程度上提高患者清醒插管的舒适度,同时清醒插管患者的血流动力学更加稳定,具有一定的临床应用价值。

Objective To investigate the clinical effects of Dezocine with surface anesthesia used in awake intubation in satiety patients with food intaken. Methods 40 patients with ASA Ⅰ, Ⅱ levels were randomly divided into 2 groups,with 20 cases in each group. Patients in group A received 1 mg/mL Dezocine 0.15 mg/kg, and those in group B received 0.15 mL/kg normal saline. 5 minutes later, conscious endotracheal intubation was respectively performed after throat mouth cavity surface anesthesia and cricothyroid membrane puncture endotracheal surface anesthesia in these two groups. The mean arterial blood pressure（MAP） and heart rate（HR） at the time point of entering operating room（T1）, cricothyroid membrane puncture endotracheal surface anesthesia（T2）, intubation（T3） and after the intubation（T4）were recorded. Then the incidence of restlessness, nausea, bucking at T2and T3were analyzed. Results There was no significant difference between general data of two groups（P〉0.05）. MAP, HR in group A were significantly lower than group B when awake intubation（P〈0.05, and the intubation times of group B [（8.7±2.7） min] was significantly longer than that of group A [（5.3±1.2） min]（P〈 0.05）. Also the restlessness scores of group B [T2：（1.2±0.7） points, T3：（1.8±0.5） points] were higher than those of group A [T2：（0.4±0.3）.points, T3：（0.6±0.4） points]. The incidence rate of nausea,buking in group B（85%） was higher than that in group A（30%）（P〈0.05）, and three patients of group B couldn＇t tolerate awake intubation and give up. Conclusion Dezocine combined with surface anesthesia can be used in awake intubation in patients with food intaken, which can increase the comfort level and maintain hemodynamics stable. It has certain value in clinical application.