不同镇静方式在可视软镜下清醒气管插管中的应用

Application of different sedation methods in awake tracheal intubation under the visible soft laryngoscope

目的探讨不同镇静方式在可视软镜下清醒气管插管中的应用效果。方法选取2018年1月~2019年1月于我院插管全麻下行择期手术治疗的40例预计困难气道患者作为研究对象,拟行可视软镜下清醒气管插管,根据镇静方式不同将其分为右美托咪定组(n=20)与咪达唑仑组(n=20)。右美托咪定组患者施以右美托咪定镇静,咪达唑仑组患者施以咪达唑仑镇静。观察两组患者入室后10 min(T0)、用药后10 min(T1)、插管成功后即刻(T2)、插管后10 min(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、呼吸频率(RR),并比较两组患者的插管总时间、不良反应总发生率、一次插管成功率。结果T0时,两组患者的MAP、HR、SpO2、RR比较,差异无统计学意义(P>0.05)。T1时,两组患者的MAP、HR、SpO2、RR比较,差异有统计学意义(P<0.05);咪达唑仑组患者T1时的MAP、HR、SpO2、RR均低于T0时,右美托咪定组患者T1时的MAP和HR均低于T0时,差异有统计学意义(P<0.05);右美托咪定组患者T1时的SpO2、RR与T0时比较,差异无统计学意义(P>0.05)。T2时,两组患者的MAP、HR、SpO2、RR比较,差异有统计学意义(P<0.05);右美托咪定组患者T2时的MAP和HR均低于T0时,差异有统计学意义(P<0.05);右美托咪定组患者T2时的SpO2、RR与T0时比较,差异无统计学意义(P>0.05);咪达唑仑组患者T2时的MAP和HR与T0时比较,差异无统计学意义(P>0.05);咪达唑仑组患者T2时的SpO2、RR与T0时比较,差异有统计学意义(P<0.05)。T3时,两组患者的MAP、HR、SPO2比较,差异无统计学意义(P>0.05);两组患者T3时的MAP、HR分别与T0时比较,差异有统计学意义(P<0.05);两组患者T3时的SpO2分别与T0时比较,差异无统计学意义(P>0.05)。右美托咪定组患者的插管总时间短于咪达唑仑组,差异有统计学意义(P<0.05)。右美托咪定组患者的不良反应总发生率低于咪达唑仑组,差异有统计学意义(P<0.05)。右美托咪定组患者的一次插管成功率高于咪达唑仑组,差异有统计学意义(P<0.05)。结论与咪达唑仑比较,右美托咪定在可视软镜下清醒气管插管中的应用具有较大优势与效果,不仅能够降低插管应激反应,血流动力学水平平稳,同时能够降低不良反应发生率,值得临床推广。

Objective To explore the application effect of different sedation methods in awake tracheal intubation under the visible soft laryngoscope.Methods Forty patients with difficult airway who underwent elective surgery under intubation general anesthesia from January 2018 to January 2019 in our hospital were enrolled.The patients underwent awake tracheal intubation under the visible soft laryngoscope,and were divided into Dexmedetomidine group(n=20)and Midazolam group(n=20)according to different sedation methods.Patients in the Dexmedetomidine group were sedated with Dexmedetomidine,and patients in the Midazolam group were sedated with Midazolam.The mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2),and respiratory rate(RR)at 10 minutes after admission(T0),10 minutes(T1)after medication,immediate after successful intubation(T2),and 10 minutes after intubation(T3)were observed.The total intubation time,the total incidence rate of adverse reactions,and the success rate of one intubation were compared between the two groups of patients.Results At T0,there were no significant differences in MAP,HR,SpO2 and RR between the two groups(P>0.05).At T1,the differences in MAP,HR,SpO2,and RR between the two groups were statistically significant(P<0.05).The MAP,HR,SpO2,and RR at T1 in the Midazolam group were lower than those at T0,and the MAP and HR in the Dexmedetomidine group at T1 were lower than those at T0, with statistically significant differences (P<0.05). There were no significant differences in SpO2 and RR between T1 and T0 in the Dexmedetomidine group (P>0.05). At T2, the differences in MAP, HR, SpO2, and RR between the two groups were statistically significant (P<0.05). In the Dexmedetomidine group, the MAP and HR at T2 were lower than those at T0, and the differences were statistically significant (P<0.05). There were no significant differences in SpO2 and RR between T2 and T0 in the Dexmedetomidine group (P>0.05). There were no significant differences in MAP and HR between T2 and T0 in the Midazolam group (P>0.05). There were statistically significant differences in SpO2, RR between T2 and T0 in the Midazolam group (P<0.05). At T3, there were no significant differences in MAP, HR, and SpO2 between the two groups (P>0.05). There were statistically significant differences in MAP and HR between T3 and T0 in the two groups (P<0.05). There was no significant difference in SpO2 between T3 and T0 in the two groups (P>0.05). The total intubation time in the Dexmedetomidine group was shorter than that in the Midazolam group, and the difference was statistically significant (P<0.05). The total incidence rate of adverse reactions in the Dexmedetomidine group was lower than that in the Midazolam group, with significant difference (P<0.05). The success rate of one intubation in the Dexmedetomidine group was higher than that in the Midazolam group, and the difference was statistically significant (P<0.05). Conclusion Compared with Midazolam, Dexmedetomidine has great advantages and effect in awake tracheal intubation under visual soft laryngoscope, which can not only reduce the intubation stress response, but also has a stable hemodynamic level. It can reduce the incidence of adverse reactions and is worthy of clinical promotion.