右美托咪定辅助经鼻清醒气管插管的效果

Efficiency of dexmedetomidine in assisting conscious transnasal trachea intubation

目的观察右美托咪定用于辅助经鼻清醒气管插管的效果。方法重度脊柱侧弯行头盆环牵引术患者100例,麻醉诱导前静脉注射舒芬太尼0.2μg/kg,行鼻咽部和环甲膜穿刺气管黏膜麻醉。随机分为两组:DEX组(53例),10min内静脉注射右美托咪定1μg/kg,继以0.2μg·kg-1·h-1输注至插管成功;SEV组(47例)采用潮气量法吸入8%七氟醚。待脑状态指数值达60~70及睫毛反射消失时,行纤维支气管镜引导经鼻气管插管。分别记录诱导前(T1)、睫毛反射消失时(T2)、插管即刻(T3)和插管后3min(T4)时的HR、MAP和SpO2,比较两组一次插管成功率和患者插管舒适度。结果 T2时SEV组MAP低于DEX组(P<0.05),HR高于DEX组(P<0.05);T3时SEV组MAP和HR均高于DEX组(P<0.05),SpO2低于DEX组(P<0.05);T4时SEV组HR高于DEX组(P<0.05)。DEX组一次插管成功率高于SEV组(P<0.05)。结论右美托咪定辅助重度脊柱侧弯患者的清醒插管可增加一次插管成功率,减轻插管应激反应。

Objective To observe the efficiency of dexmedetomidine in assisting conscious transnasal trachea intubation.Methods A total of 100 patients with severe scoliosis undergoing selective pelvic ring traction was randomly assigned into two groups.Sufentanil 0.2 μg/kg was injected and nasopharynx and trachea surface anesthesia was performed before induction in both groups.The patients in group DEX（53cases）were injected dexmedetomidine 1μg/kg in 10minutes,which was followed by infusion of dexmedetomidine 0.2μg·kg^-1·h^-1 untill comletion of intubation.The patients in group SEV（47cases）were inhaled 8% sevoflurane with tidal-volume method.The transnasal tracheal intubation was performed under the guidance of fiber bronchoscope when cerebral state index fluctuated between 60-70and eyelash reflex loss.The HR,MAP and SpO2 were recorded before induction（T1）,eyelash reflex loss（T2）,during intubation（T3）and three minutes after intubation（T4）.The success rate of single-attempt intubation and patient intubation comfort were compared between two groups.Results MAP was lower,and HR was higher in group SEV than those in group DEX at T2（P〈0.05）.MAP and HR were higher and SpO2 was lower in group SEV than those in group DEX at T3（P〈0.05）.HR was higher in group SEV than that in group DEX at T4（P〈0.05）.The success rate of single-attempt intubation was higher in group DEX than that in group SEV （P〈0.05）.Conclusion Dexmedetomidine in assisting conscious transnasal trachea intubation can improve the success rate of single-attempt intubation and reduce the stress response to intubation.