瑞芬太尼复合右美托咪定用于清醒气管插管的最佳剂量初探

Study on the optimal dose of remifentanil combined with dexmedetomidine for awake tracheal intubation

目的 初步探讨瑞芬太尼复合右美托咪定用于清醒气管插管的最佳剂量。方法 选取2014年3月~2016年8月期间金华市人民医院的择期困难气道全麻手术患者60例,随机分为R1、R2、R3组,每组各20例。0.6μg/kg右美托咪定10 min微泵静注,同时靶控输注效应室浓度瑞芬太尼,R1组：瑞芬太尼2.0 ng/m L;R2组：瑞芬太尼2.3 ng/m L和R3组：瑞芬太尼2.5 ng/m L。所有患者均在可视软镜引导下用2%利多卡因充分表面麻醉。记录入室时（T0）、给药结束时（T1）、插管时（T2）,插管完成后即刻（T3）时心率（HR）、平均动脉压（MAP）及Ramsay镇静评分;气管导管置入反应评分并记录气管插管过程中呼吸抑制、心血管不良反应的发生情况;术后随访气管插管过程的满意度。结果 T2、T3时R1组MAP明显高于R2组、R3组,心率明显快于R2组、R3组,呼吸频率明显快于R2组、R3组,差异有统计学意义（P〈0.05）。不良反应中R3组的高血压发生率明显低于R1组、而呼吸抑制及心动过缓的发生率明显高于R1组,R3组RSS评分及满意度评分明显高于R1组,R3组气管导管置入反应评分明显高于R1组,差异均有统计学意义（P〈0.05）。组内比较R1组T2、T3时血压明显高于T1时,心率明显快于T1时、呼吸频率明显快于T1时,差异有统计学意义（P〈0.05）;R3组T2、T3时呼吸频率明显慢于T0时,差异有统计学意义（P〈0.05）。结论 右美托咪定复合瑞芬太尼在可视插管软镜引导下对困难气管患者清醒插管是安全有效的,在充分的气道表面麻醉下,右美托咪定微泵0.6μg/kg同时靶控输注效应室浓度瑞芬太尼2.3 ng/m L是较合理的用药。

Objective To investigate the optimal dose of remifentanil combined with dexmedetomidine for awake tracheal intubation. Methods 60 cases with difficult airway general anesthesia surgery from March 2014 to August 2016 in Jinhua Peopled Hospital were selected and divided into group R1, R2, R3, 20 cases in each group. 0. 6 （jug/kg dexmedetomidine 10 minutes micro pump intravenously, Simultaneous target-controlled infusion effect of the chamber concentration of remifentanil. 2. 0 ng/mL remifentanil in group R1, 2. 3 ng/mL remifentanil in group R2, 2. 5 ng/mL remifentanil in group R3. All patients underwent full surface anesthesia with 2% lidocaine under visual soft mirror guidance. The heart rate （HR）,mean arterial pressure （ MAP） and Ramsay sedation score at before anesthesia （ T0 ） , at the end of the administration （Tj ） , intubation （ T2） , immediately after intubation （ T3） , tracheal catheter placement reaction score and record tracheal intubation during respiratory depression, cardiovascular adverse events, postoperative follow-up of tracheal intubation process satisfaction. Results MAP, HR and RR at T2 ,T3 in group R1 were significantly higher than those in group R2 and R3, the difference was statistically significant （P 〈 0. 05 ）. The incidence of hypertension in the group R3 was significantly lower than that in group R1, while the incidence of respiratory depression and tachycardia was significantly higher than that in group R1, the difference was statistically significant （ P 〈 0. 05 ） , RSS score and satisfaction scores in group R3 were significantly higher than those in group R1, the reaction score in group R3 was significantly lower than the group R1, the difference was statistically significant （ P 〈 0. 05 ）. Within group comparison, the mean arterial pressure and heart rate and respiratory rate at T2 and T3 in group R1 was significantly higher than those at Tj , heart rate was significantly faster than Tj , the respiratory rate was significantly faster than Tj , the difference was statistically significant （ P 〈 0. 05 ） , T2 and T3 in group R3 were significantly slower than those at T0 , the difference was statistically significant （ P 〈 0. 05 ）. Conclusion Remifentanil combined with dexmedetomidine can be safely and effectively used for awake intubation under glidescope guiding in difficult airway patients. In the full airway surface anesthesia, dexmedetomidine micropump 0. 6 （jug/kg simultaneous target transfusion effect of the concentration of remifentanil 2. 3 ng/mL is a more reasonable medication.