不同剂量右美托咪定联合七氟醚诱导在保留自主呼吸气管插管中的对比研究

Comparison of Different Doses of Dexmedetomidine Combined with Sevoflurane Induction in Tracheal Intubation with Spontaneous Breathing

目的观察不同剂量右美托咪定联合七氟醚保留自主呼吸气管插管的效果。方法选择2017年1月～12月在绵阳市中心医院麻醉科行气管插管全麻患者120例,采用随机数字表法分为四组,每组30例。七氟醚组(C组):等量生理盐水静脉泵入+七氟醚吸入;试验组(D1、D2、D3组):不同剂量右美托咪啶(0.8、1、1.2μg/kg负荷量,诱导前10 min内静脉泵入)+七氟醚吸入。Viby-Mogeneon气管插管条件分级标准评价气管插管条件。记录入室后(T1)、右美托咪定注射后(T_2)、插管前(T_3)、插管后即刻(T_4)HR、平均动脉压(MAP)。结果与T_1比较,C组T_4时点MAP、HR升高,D2组T3时点及D3组T_2、T_3、T_4时点HR下降(P<0.05);与C组比较,D1、D2、D3组T2、T3、T4时点HR下降;D1、D2、D3组插管满意率高(P<0.05);与D1组比较,D2组T_2、T_3及D3组T_2、T_3、T_4时点HR下降(P<0.05);与D2组比较,D3组T_3、T_4时点HR下降(P<0.05)。D3组出现1例患者HR<50次/min。四组均无SP<80 mmHg病例。结论右美托咪定联合七氟醚用于保留自主呼吸气管插管安全有效,1μg/kg为较适宜剂量。

Objective To observe the effect of different doses of dexmedetomidine combined with sevoflurane on tracheal intubationwith spontaneous breathing.Methods 120 patients with general anesthesia for tracheal intubation in the Department ofAnesthesiology,Mianyang Central Hospital from January to December 2017 were randomly divided into four groups,30 in each group.Sevoflurane group（group C）：equal volume of saline intravenously inhaled＋sevoflurane inhalation; test group（D1,D2,D3 group）：Differentdoses of dexmedetomidine （0.8,1,1.2μg/kg load,intravenous pumping within 10 min before induction）＋sevoflurane inhalation.Viby-Mogeneon tracheal intubation condition grading criteria were evaluated for tracheal intubation conditions.After the entry into the room（T1）,after dexmedetomidine injection（T2）,before intubation（T3）,immediately after intubation（T4）HR,mean arterial pressure（MAP）. ResultsCompared withT1,MAP and HR increased atT4 in group C,the HR of D2 groupT3 and D3 groupT2,T3,T4decreased（ P〈0.05）;comparedwith C group,D1,T2,D3 groupT2,T3,T4HR decreased;the satisfaction rate of intubation in D1,D2 and D3 groups was high（ P〈0.05）.Compared with D1 group,the HR ofT2,T3 in D2 group and in D3 group decreased atT2,T3 andT4 （ P〈0.05）.Compared with the D2group,the HR of theT3 andT4 points in the D3 group decreased（ P〈0.05）.One patient in the D3 group had HR〈50 beats/min.Therewere no cases of SP 〈80mmHg in all four groups.Conclusion Dexmedetomidine combined with sevoflurane can be safely andeffectively used for the retention of spontaneous respiratory tracheal intubation,and1μg/kg is the appropriate dose.