舒芬太尼复合右美托咪定用于纤支镜引导清醒气管插管的对照研究

Comparative study of sufentanil combined with dexmedetomidine on the awake patients with fiber bronchoscope intubation

目的观察不同剂量舒芬太尼复合右美托咪定用于纤支镜引导清醒插管的麻醉效果。方法选择遵义市第一人民医院2012年1月至2013年12月间需要进行纤支镜引导清醒插管的患者118例,分为3组:Ⅰ组(40例)、Ⅱ组(42例)、Ⅲ组(36例)。先给予1μg/kg的右美托咪定,然后持续0.2μg/kg持续泵注后分别静脉注射舒芬太尼0.1μg/kg(Ⅰ组)、0.2μg/kg(Ⅱ组)、0.3μg/kg(Ⅲ组)。记录入手术室后5min作为基础值(T0),注药后(T1),插管即刻窥视会厌(T2),插管后1min(T3),插管后5min(T4),观察心率(HR)、平均动脉压(MAP),脉搏血氧饱和度(SpO2)变化,记录插管过程中不良反应。结果与Ⅰ组相比,Ⅱ、Ⅲ组T2、T3的HR显著降低(P<0.05),Ⅱ、Ⅲ组T2、T3MAP显著降低(P<0.05)。与Ⅰ、Ⅱ组相比,Ⅲ组T2SpO2显著降低(P<0.05)。Ⅰ组发生呛咳反应显著高于Ⅱ、Ⅲ组(P<0.05),只有Ⅲ组发生呼吸抑制。结论静注舒芬太尼0.2μg/kg复合右美托咪定用于纤支镜引导清醒气管插管,能有效抑制应激反应,且循环稳定,不良反应少。

Objective To observe the effect of different doses of sufentanil on intubation guided by fiber bronchoscope in difficult airways .Methods One hundred and eighteen patients with difficult airways who underwent tracheal intubation were randomly divided into 3 groups [groupⅠ（n=40） ,groupⅡ （n=42） ,and groupⅢ （n=36）] .First all group received 1 μg/kg dexmedetomidine ,then groupⅠ ,groupⅡ and group Ⅲ received sufentanil 0 .1μg/kg ,0 .2 μg/kg ,0 .3μg/kg infusion in bolus respectively .Heart rate（HR） ,mean arterial pressure（MAP）and saturation of pulse oximetry（SpO2 ）were recorded at 5 min after patients arriving at operation room （T0 ） ,after drug infusion（T1 ） ,the time of intubation and seeing the epiglottis （T2 ） ,1 min（T3 ）and 5 min（T4 ）after intubation .side effect was recorded throughout the process .Results HR at T2 and T3 in groupⅡ and group Ⅲ were significantly lower than those in group Ⅰ（P〈0 .05） .MAP at T2 and T3 in groupⅡ and group Ⅲ were significantly lower than those in groupⅠ（P〈0 .05） .SpO2 at T2 in group Ⅲ was significantly lower than those of groupⅠ and groupⅡ（P〈0 .05） .Cough reflex in groupⅠwas much frequent than others .Only group Ⅲ had respiratory inhibition .Conclusion Intravenous sufentanil （0 .2 μg/kg）could inhibit effectively stress reaction from endotracheal intubation ,in which less side effects such as haemodynamic changes and respiratory depression occur .