不同剂量芬太尼、氟哌利多复合达克罗宁用于清醒气管插管的临床观察

Clinical observation of different dosages of fentanyl, droperidol combined with dyclonine for awake tracheal intubation

目的分析可能存在困难气道者临床以不同剂量芬太尼、氟哌利多复合达克罗宁行清醒气管插管可行性、有效性。方法将2015年3月～2018年3月期间医院收治的100例存在气管插管困难可能者作为本次观察对象,所有患者术中均以芬太尼、氟哌利多复合达克罗宁行清醒气管插管,随机分组其中A组34例(芬太尼2μg/kg、氟哌利1μg/kg)、B组33例(芬太尼3μg/kg、氟哌利2μg/kg)、C组33例(芬太尼4μg/kg、氟哌利3μg/kg),观察三组患者各个时间点(入室时、喉镜置入时、插管即刻、插管后3min)心率(HR)、收缩压(SBP)、血氧饱和度(SPO2)、舒张压(DBP)指标变化,统计芬太尼、氟哌利多不同剂量患者术中呛咳发生情况。结果 A组呛咳发生率高于B、C组,P <0.05;T2时三组血液流动力学指标水平均有下降,且C组水平低于A、B组,P <0.05;T3、T4时三组SBP、DBP、HR均有增高,A组水平高于B、C组,P <0.05。结论临床以氟哌利多、芬太尼符合达克罗宁用于清醒气管插管麻醉时,选择2μg/kg、3μg/kg的配比方案,术中血流动力学波动稳定,安全性高,呛咳发生少。

Objective To analyze the feasibility and effectiveness of awake tracheal intubation with different dosages of fentanyl,droperidol combined with dyclonine in patients with potentially difficult airway.Methods 100 patients with possible tracheal intubation difficulties who were admitted and treated in our hospital from March 2015 to March 2018 were selected as research objects and all patients were given fentanyl,droperidol combined with dyclonine for awake tracheal intubation.They were randomly divided into A group with 34 cases(fentanyl 2μg/kg,droperidol 1μg/kg),B group with 33 cases(fentanyl 3μg/kg,droperidol 2μg/kg)and C group with 33cases(fentanyl 4μg/kg,droperidol 3μg/kg).The changes in heart rate(HR),systolic blood pressure(SBP),blood oxygen saturation(SPO2),and diastolic blood pressure(DBP)indexes at each time point(at the time of admission,laryngoscope implantation,immediate after intubation and 3min after intubation)of patients in the three groups were observed.And the incidence of intraoperative irritating cough in patients with different dosages of fentanyl and droperidol was statistically analyzed.Results The incidence of irritating cough in A group was higher than that in B group and C group,P<0.05.The levels of hemodynamics in the three groups were all decreased at T2,and the level in C w group was lower than that in A group and B group,P<0.05.The levels of SBP,DBP and HR were all increased at T3 and T4,and the levels in A group were higher than those in B group and C group,P<0.05.Conclusion When clinically using droperidol,fentanyl combined with dyclonine for awake tracheal intubation anesthesia,the ratio scheme of 2μg/kg and 3μg/kg is selected,with stable intraoperative hemodynamic fluctuation,high safety and less cough.