舒芬太尼/右美托嘧啶辅助表面麻醉减轻气管插管应激反应的研究

Study on the clinical efficacy of dexmedetomidine and sufentanil assisted surface anesthesia relieving cardiovascular response in endotracheal intubation

目的比较舒芬太尼(SUF)与右美托嘧啶(DEX)2种辅助表面麻醉方法,在患儿经口清醒气管插管中的应用及对减轻应激反应的临床疗效。方法入选我院经口清醒气管插管患儿92例,随机单盲分为A组(47例)与B组(45例),在利多卡因复合丁卡因联合表面麻醉之前,A组插管前泵注DEX 10min,B组静脉注射SUF 5min,记录并对比2组表面麻醉前与插管后即刻、插管后3min和插管后5min的去甲肾上腺素(NE)、血压和心率等的变化情况。结果 12组患者插管后,去甲肾上腺素、收缩压和心率等指标均较之基础值呈现一过性升高,插管后5min各指标基本恢复至基础值水平;2插管后即刻,B组NE、SBP、DBP和HR等指标远高于A组水平;插管后3min,2组NE和SBP差异具有统计学意义;插管后5min,2组NE差异具有统计学意义。结论清醒状态下经口气管插管中,使用DEX辅助表面麻醉较之SUF能更有效地抑制插管引起的应激反应,对减轻心血管反应具有相对优势。

Objective To conduct a comparative study on the reactions alleviation between application of sufentanil（SUF）and dexmedetomidine（DEX）for auxiliary topical anesthesia in endotracheal intubation on awake children.Methods 92 admitted awake tracheal intubation patients were randomly divided into observation group（47cases）and control group（45cases）.All cases were implemented topical anesthesia by lidocaine and tetracaine,based on which,the observation group were infused with DEX for 10 min before intubation,while the control group received intravenous injection of SUF for 5 min,and indicators of norepinephrine concentration of hemodynamic variation and stress reaction were noted and compared between the 2groups before and after 0,3and 5min the endotracheal intubation.Results 1Patients of the 2groups,norepinephrine（NE）,systolic blood pressure（SBP）,heart rate（HR）after intubation presented a transient increase compared with basic value,and about 5min after intubation,the 3indicators returned to the baseline;2Patients in the control group after intubation,3min after intubation,5min after intubation,NE,SBP and HR level were higher than those in observation group.The difference of all indexes after intubation had statistical significance.Conclusion Application of DEX in auxiliary surface anesthesia can reduce intubation stress reaction,and showed comparative advantages compared with SUF.