不同剂量右美托咪定对视频喉镜清醒镇静插管时心血管反应的影响

Influence of different doses of dexmedetomidine on cardiovascular response during awake intubation with video laryngoscope

目的观察不同剂量右美托咪定对视频喉镜清醒镇静插管时心血管反应的影响。方法择期气管插管全麻手术患者90例,ASAⅠ或Ⅱ级,MallampatiⅠ或Ⅱ级,随机均分为三组,D1组:右美托咪定0.8μg/kg+瑞芬太尼0.5μg/kg;D2组:右美托咪定1.0μg/kg+瑞芬太尼0.5μg/kg和D3组:右美托咪定1.2μg/kg+瑞芬太尼0.5μg/kg。插管前15min三组患者分别按上述剂量缓慢静脉泵注右美托咪定(10min泵注完毕),插管前90s快速静注瑞芬太尼,并在气管完善表面麻醉的基础上,行视频喉镜插管。记录入室后安静10min(基础值,T0)、喉镜置入前(T1)、气管插管后即刻(T2)时HR、MAP及Ramsay镇静评分;并记录插管时间、气管插管过程中躁动、呛咳、呼吸抑制、心血管不良反应的发生情况;术后随访患者对气管插管过程的知晓情况。结果 T1时三组HR明显慢于、MAP明显低于T0时(P<0.05);T2时D1组HR明显快于、MAP明显高于D2、D3组(P<0.05)。T1、T2时D1组Ramsay镇静评分明显低于D2、D3组(P<0.05)。D1组高血压、心动过速、躁动、呛咳等不良反应的发生率明显高于D2、D3组(P<0.05)。D3组心动过缓、呼吸抑制发生率明显高于D1、D2组(P<0.05)。结论在完善的气道表面麻醉基础上,右美托咪定1μg/kg复合瑞芬太尼0.5μg/kg可以明显抑制视频喉镜清醒镇静插管时的心血管反应,并且不良反应少,是较为合理的临床用药剂量。

Objective To investigate the influence of different doses of dexmedetomidine on cardiovascular response during awake intubation with video laryngoscope.Methods Ninety ASA ⅠorⅡ patients scheduled to receive general anesthesia were randomly divided into 3groups（n=30each）：group D1 received intravenously dexmedetomidine 0.8μg/kg plus remifentanil 0.5μg/kg;group D2 with dexmedetomidine 1.0μg/kg plus remifentanil 0.5μg/kg;and group D3 with 1.2μg/kg plus remifentanil 0.5μg/kg.Tracheal intubation was performed with video laryngoscope 90 s after rapid remifentanil injection and complete topical anesthesia.HR,MAP and Ramsay sedation scale were recorded before anesthesia（T0,baseline）,before intubation（T1）,immediately after intubation（T2）.The intubation time,side effects during intubation and awareness of intubation were also recorded.Results HR and MAP at T1 in three groups were significantly lower than those at T0（P〈0.05）;HR and MAP at T2 in group D1 were significantly higher than those in group D2 and D3.Ramsay sedation scales at T1 and T2 in group D1 were lower than those in group D2 and D3（P〈0.05）.The incidences of bradycardia and respiratory depression in group D3 were higher than those in group D1 and D2;The incidences of hypertension,tachycardia,restlessness and bucking in group D1 were higher than those in group D2 and D3（P〈0.05）.The post operative follow-up showed that no patient recalled the discomfort and pain during intubation.Conclusion Dexmedetomidine 1μg/kg combined with remifentanil 0.5μg/kg together with topical anesthesia is a good method for video laryngoscopic awake intubation with lighter cardiovascular response and less side effects.