瑞芬太尼应用于悬雍垂腭咽成形术清醒气管插管的临床观察

Clinical observation of remifentanil applied in conscious endotracheal intubation for obstructive sleep apnea syndrome

目的探讨瑞芬太尼配合光纤喉镜下经鼻腔清醒气管插管用于悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征(OSAS)的效果。方法 80例OSAS患者,随机分为两组,每组40例。右美托咪定组(D组)、右美托咪定加瑞芬太尼组(DR组)。两组均静脉输注右美托咪定(DEX),DR组缓慢加静脉滴注瑞芬太尼。记录插管即刻(T1)、插管后5 min(T2)、插管后10 min(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2),插管完成时间及插管次数,有无呛咳及不良回忆、躁动、呼吸抑制等麻醉慢诱导不良反应。结果两组T1、T2、T3时的MAP、HR比较,DR组显著低于D组,差异具有统计学意义(P<0.05)。两组呛咳、不良回忆、躁动比较,差异具有统计学意义(P<0.05)。结论在右美托咪定的基础上加用瑞芬太尼,可完善经鼻清醒气管插管镇静、镇痛的效果,不抑制呼吸,血流动力学平稳,应激反应轻,可提供良好的气管插管条件,适用于阻塞性睡眠呼吸暂停综合征的临床治疗。

Objective To investigate the effect of remifentanil combined with fiber laryngoscope through nasal cavity conscious endotracheal intubation for obstructive sleep apnea syndrome（OSAS） treated by uvulopalatopharyngoplasty. Methods A total of 80 OSAS patients were randomly divided into two group with 40 cases in each group as dexmedetomidine group（group D） and dexmedetomidine plus remifentanil group（group DR）. Both groups received intravenous injection of dexmedetomidine（DEX）, and the group DR was given slow intravenous drip of remifentanil. Mean arterial pressure（MAP）, heart rate（HR） and oxyhemoglobin saturation（SpO2） were recorded at intubation（T1）, 5 min after intubation（T2）, and 10 min after intubation（T3）. Records were also made on intubation completion time, intubation times, cough and bad memories, restlessness, respiratory inhibition of slow anesthesia induced adverse reaction. Results Compared with group D, group DR had much lower levels of MAP and HR in T1, T2, and T3. The difference had statistical significance（P〈0.05）. The difference of adverse reactions of cough and bad memories, and restlessness had statistical significance between the two groups（P〈0.05）. Conclusion Additional implement of remifentanil on the basis of dexmedetomidine can improve sedation and analgesia effects of conscious endotracheal intubation through nasal cavity without inhibiting breath. It has stable haemodynamics and slight stress reaction, and can good condition for endotracheal intubation. This method is suitable for clinical treatment of obstructive sleep apnea syndrome.