右美托咪定用于老年患者纤维支气管镜气管插管剂量的探讨

Optimal dosage of dexmedetomidine for sedation during awake fiberoptic intubation in elder patients

目的观察右美托咪定（dexmedetomidine，Dex）用于老年患者纤维支气管镜（纤支镜）插管的临床效果，并探讨其最佳剂量。方法选择120例65～90岁ASA分级Ⅱ、Ⅲ级拟行纤支镜插管的患者，采用随机数字表法将患者分为D1、D2、D3、D4组（每组30例），分别于10rain内输注负荷量为0．2、0．4、0．6、0．8μg／kgDex，然后4组患者均按0．2μg·kg^-1·h^-1Dex维持，记录入室时（T0）、插管前（T1）、纤支镜经声门即刻（T2）、插管后1min（T3）、插管后3min（T4）、插管后10min（T5）的MAP、HR和警觉与镇静评分（observer＇s assessment of alertness/sedation，OAA／S），并记录插管所用时间，评价插管耐受度、满意度。结果与T0时点比较，T1-T5时点Dl、D2、D3、D4组OAA／S评分明显降低（P〈0．05），D2、D3、D4组MAP明显降低（P〈0．05），T2时点的Dl组和D2组HR明显增快（P〈0．05），D3组和D4组HR明显降低（P〈0．05）；与Dl组比较，T2～B时点D3组和D4组OAMS评分、HR和MAP明显降低（P〈0．05）；与D2组比较，即T4-T5时点D4组OAA／S评分明显降低，T2～T5时点D4组MAP和HR明显降低。4组的插管成功率均为100％，D2、D3、D4组插管时间短于Dl组（P〈O．05），插管耐受度和满意度均优于D1组（P〈0．05）。结论Dex用于老年患者纤支镜插管时，使用负荷剂量0．4～0．6μg／kg镇静充分，而且对呼吸、循环系统影响小。

Objective Exploring the effect and the optimal dosage of dexmedetomidine（Dex） during fiberoptic intubation in elder patients. Methods One hundred and twenty patients, ASA Ⅱ or Ⅲ, were randomly divided into four groups with the random number table （n=30）： D1, D2, D3 and D4. Four groups received Dex loading dose of 0.2, 0.4, 0.6, 0.8 μg/kg respectively, all the dose were given in ten minutes, then followed with 0.2 μg·kg^-l·h^-1. MAP, HR, SpO2 maintenance. Observer＇s assessment of alertness/ sedation（OAA/S） score were recorded at baseline（T0）, the time before intubation （T1）, the time when bronchofiberscope reaching glottis （T2）, 1 rain after intubation （T3）, 3 rain after intubation （T4） and 10 min after intubation （T5）. Intubation time, intubation tolerance, and satisfaction rate were also recorded. Results Compared with To, OAA/S decreased significantly at T1-T5 in group D1, D2, D3 and D4（P〈0.05）, MAP decreased significantly in group D2, D3 and D4（P〈0.05）, HR increased significantly at T2 in group D1 and D2（P〈O.05）. Compared with D1, OAA/S, HR, MAP decreased significantly at T2-T5 in group D3 and D4 （P〈0：05）. Compared with D2, OAA/S decreased significantly at T4-T5 in group D4. MAP and HR were decreased significantly at T2-T5 in group D4. The incubation success rates of 4 groups were 100%. The intubation time in group D2, D3 and D4 were significantly shorter than group D1 （P〈0.05）. Group D2, D3 and D4 were significantly calmer and more cooperative during waking time for fiberoptic incubation, they were also more satisfied with the awake fiberoptic incubation than group D1 （P〈0.05）. Conclusions Dex at a loading dose 0.4-0.6 μg/kg intravenously can be used safely in bronehofibroscopy for eider patients with less cardiovascular and respiratory depression and with more tolerance and satisfaction.