不同剂量右美托咪定复合靶控瑞芬太尼在成人清醒气管插管中应用研究

Intubation application study of different doses of dexmedetomidine given composite target-controlled remifentanil awake in adults

目的探讨不同剂量右美托咪定复合靶控瑞芬太尼在成人清醒气管插管中的应用。方法选取2011年3月至2013年3月行全麻手术患者36例,随机分为第一组、第二组和第三组,每组各12例。所有患者口腔、咽喉部表面麻醉后,静脉泵注0.8μg/kg右美托咪定的负荷剂量,第一组患者以0.25μg/(k·h)作为维持剂量,第二组患者以0.5μg/(k·h)作为维持剂量,第三组患者以1.0μg/(k·h)作为维持剂量。同时靶控输注瑞芬太尼4 ng/ml。当脑电双频指数(BIS)值小于55时,行气管插管。记录麻醉前(T0)、插管前即刻(T1)、插管完成后1 min(T2)、插管完成后5 min(T3)的平均动脉压(MAP)、血氧饱和度(Sp O2)、心率和BIS变化。观察插管前后心动过缓、呛咳、呼吸抑制和恶心的发生情况。结果各组患者MAP先下降后上升,且第三组患者T2、T3时间点MAP与同组T0时间点比较明显升高,差异具有统计学意义(P<0.05);第三组患者T1、T2、T3时间点Sp O2下降明显,与T0时间点比较,差异具有统计学意义(P<0.05);各组患者心率先下降后上升,BIS都出现不同程度的降低,第二组、第三组患者T2、T3时间点HR和BIS与同时间点的第一组比较明显降低,差异具有统计学意义(P<0.05);第三组患者心动过缓和呼吸抑制的发生率明显高于第一和第二组,差异具有统计学意义(P<0.05)。结论 0.5μg/(k·h)作为维持剂量的右美托咪定复合靶控瑞芬太尼对成人清醒气管插管具有很好的麻醉效果,能获得稳定的血流动力学,且不良反应发生率低。

Objective To investigate different doses of dexmedetomidine given composite target- controlled remifentanil in adult awake tracheal intubation. Methods Between March 2011 and March 2013 in our hospital,anesthesia 36 patients were randomly divided into the first group,the second group and the third group,12 cases were included in each group. All patients were given surface anesthesia in the mouth,throat. The intravenous infusion 0. 8 μg / kg of dexmedetomidine was given a loading dose. The first group of patients was given with 0. 25 μg /（ k·h） as a maintenance dose. The second group patients was given with 0. 5 μg/（ k·h） as a maintenance dose. The third group of patients was given 1. 0 μg /（ k·h） as a maintenance dose. Meanwhile target- controlled infusion of remifentanil 4 ng / ml. When BIS values were less than 55.These patients were given endotracheal intubation. Anesthesia condition before（ T0）,before intubation（ T1）,intubation 1 min（ T2）,5min（ T3） of MAP,Sp O2,heart rate and changes in BIS after intubation were recorded. The before and after intubation bradycardia,cough,respiratory depression and nausea occurrence were recorded. Results The patients in each group after the first decline in MAP increased. The third group of patients with T2,T3 was compared T0 time point with the same point in time MAP group. The difference was statistically significant（ P〈0.05）. The third group of patients with T1,T2,T3 time Sp O2 decreased significantly compared with T0 time point. The difference was statistically significant（ P〈0. 05）. The increase of each group took the lead after cardiac decline. BIS showed varying degree of reduction. The second group,the third group of patients T2,HR and BIS T3 time points were compared with the same time the first set point,which showed a significant difference（ P〈0. 05）. The incidence of bradycardia and respiratory depression third group of patients was significantly higher than that of the first and second group（ P〈0. 05）. Conclusion 0. 5 μg /（ k·h） as a maintenance dose of dexmedetomidine can give composite target- controlled remifentanil awake tracheal intubation in adults. This method showed good anesthetic effect,and can get a stable hemodynamic and low incidence of adverse reactions.