不同剂量右美托咪定用于高血压患者行纤维支气管镜清醒气管插管的效果比较

Comparison of different doses of dexmedetomidine in the fiber optic bronchoscope-based conscious tracheal intubation in hypertensive patients

目的:探讨高血压患者行纤维支气管镜清醒气管插管时采用不同剂量右美托咪定的临床效果及影响。方法:将我院2014年5月—2017年8月期间收治的100例高血压患者作为研究对象,所有患者均行纤维支气管镜(FOB)清醒气管插管。按随机数字表法将患者分为5组,每组20例。其中,A组插管前15 min注射10 mL生理盐水;B组静脉注射0.1μg·kg^(-1)舒芬太尼+生理盐水稀释至10 mL静脉泵入;C组给予0.5μg·kg^(-1)右美托咪定+生理盐水稀释至10 mL静脉泵入;D组给予1.0μg·kg^(-1)右美托咪定+生理盐水稀释至10 mL静脉泵入;E组给予2.0μg·kg^(-1)右美托咪定+生理盐水稀释至10 mL静脉泵入。所有患者插管前10 min给予1%丁卡因5 mL进行口腔、咽喉等局部表面麻醉。所有患者均由同一位医师进行FOB清醒气管插管,之后给予0.3 mg·kg^(-1)依托咪酯、0.2 mg·kg^(-1)顺阿曲库铵、4μg·kg^(-1)芬太尼以及0.05 mg·kg^(-1)咪达唑仑加深麻醉。观察5组患者的血流动力、应激反应以及不良反应情况。结果:5组患者在T0和T1时平均动脉压(MAP)以及血氧饱和度(SpO_2)水平无统计学差异(P>0.05);T0时心率(HR)无统计学差异(P>0.05)。T2~T3时,A组患者的HR和MAP水平升高幅度最大,SpO_2水平降低幅度最大;其次为B组和C组;D组和E组波动幅度较小,相对于其他3组的血流动力学更平稳(P<0.05)。D组患者血流相对于E组患者更稳定(P<0.05)。T0~T1时,5组患者的肾上腺素(E)和去甲肾上腺素(NE)水平无统计学差异(P>0.05)。T2~T3时,A组E和NE水平波动幅度最大;其次为B组和C组;D组和E组波动幅度最小,相对于其他3组应激反应更平稳(P<0.05)。A组术中容易发生高血压、心动过速和躁动,发生率高于其他4组(P<0.05)。B组和C组高血压及心动过速发生率高于D组和E组(P<0.05)。B组和E组呼吸抑制发生率高于其他3组(P<0.05)。E组心动过缓发生率高于其他4组(P<0.05)。D组不良反应率最低。结论:高血压患者静脉注射右美托咪定1.0μg·kg^(-1)可以有效减少患者行FOB清醒气管插管麻醉时的心率、血压变化,降低应激反应,且不良反应发生较少,值得在临床应用及推广。

Objective： To compare the clinical effect of different doses of dexmedetomidine in the fiber optic bronchoscope（ FOB）-based conscious tracheal intubation in hypertensive patients. Methods： Totally 100 hypertensive patients receiving the FOB-based conscious tracheal intubation from May 2014 to August 2017 in our hospital were selected. The subjects were randomly divided into five groups（ n = 20）. They were treated withintravenous injection via a venous pump of 10 mL saline（ group A）,0. 1 μg·kg（-1） sufentanil（ group B）,0. 5 μg·kg（-1） dexmedetomidine（ group C）,1. 0 μg·kg（-1） of dexmedetomidine（ group D）,or 2. 0 μg·kg（-1） dexmedetomidine（ group E） 15 min before intubation. Their hemodynamic indexes,stress responses and adverse reactions were observed. Results： At T0 and T1,MAP and SpO_2 did not differ significantly（ P 〉0. 05）; at T0,HR did not significantly change（ P 〉0. 05）. From T2 to T4,the fluctuation range of HR,MAP and SpO_2 was the highest in group A,followed by groups B and C,and then groups D and E. The hemodynamic indexes were more stable in groups D and E（ P 〈0. 05）. The HR at T1 and T0 was not significantly different in group D,but significantly different in group E. The hemodynamic index was more stable（ P 〈0. 05） in group D. From T0 to T1,the levels of E and NE was not significantly different（ P 〉0. 05）,but from T2 to T4,the levels fluctuated. The fluctuation range of E and NE was the highest in group A,followed by groups B and C,and then D and E. The stress responses were more stable in groups D and E（ P 〈0. 05）. The incidence of hypertension,tachycardia and dysphoria was the highest in group A（ P 〈0. 05）; the incidence of hypertension and tachycardia was higher in groups B and C than groups D and E（ P 〈0. 05）. The incidence of respiratory depression was the highest in groups B and E（ P 〈0. 05）; the incidence of bradycardia was highest in group E（ P 〈0. 05）. The adverse event rates were the lowest in group D. Conclusion： The intravenous injection of 1. 0 μg·kg（-1） dexmedetomidine has a better effect in the FOB-based conscious tracheal intubation; it has less impact on the hemodynamic index,and reduces the stress responses and adverse reactions.