中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
11期
1306-1309
,共4页
右美托咪啶%哌啶类%支气管镜检查%插管法,气管内%清醒镇静
右美託咪啶%哌啶類%支氣管鏡檢查%插管法,氣管內%清醒鎮靜
우미탁미정%고정류%지기관경검사%삽관법,기관내%청성진정
Dexmedetomidine%Piperidines%Bronchoscopy%Intubation,intratracheal%Conscious sedation
目的 比较右美托咪啶与瑞芬太尼用于纤维支气管镜引导经鼻清醒气管插管的效果.方法 预期困难气道择期拟行纤维支气管镜引导经鼻清醒气管插管的外科手术患者40例,年龄18～73岁,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将其分为2组(n=20):右美托咪啶组(D组)和瑞芬太尼组(R组).D组先静脉注射右美托咪啶负荷量1.0 μg/kg,再以0.5 μg·kg-1·h-1的速率静脉输注；R组靶控输注瑞芬太尼,血浆靶浓度3.2ng/m.D组负荷量注射结束、R组达血浆靶浓度时进行气管插管.气管插管期间行Ramsay镇静评分；评价气管插管条件和患者对气管插管的耐受性；记录气管插管时间、气管插管成功情况、气管插管期间心血管反应、低氧血症的发生情况；术后24h回访,记录咽喉疼痛、声音嘶哑的发生情况,记录患者对气管插管的满意度评分和对气管插管的记忆情况.结果 与R组比较,D组Ramsay镇静评分升高,气管插管条件和耐受性提高,气管插管时间缩短,气管插管首次成功率升高,术后满意度评分升高,不良反应发生率降低,气管插管记忆评分降低(P＜0.05).结论 与瑞芬太尼比较,右美托咪啶用于纤维支气管镜引导清醒气管插管时能提供更好的插管条件,不良反应少,且可抑制气管插管知晓的发生.
目的 比較右美託咪啶與瑞芬太尼用于纖維支氣管鏡引導經鼻清醒氣管插管的效果.方法 預期睏難氣道擇期擬行纖維支氣管鏡引導經鼻清醒氣管插管的外科手術患者40例,年齡18～73歲,ASA分級Ⅰ～Ⅲ級,採用隨機數字錶法,將其分為2組(n=20):右美託咪啶組(D組)和瑞芬太尼組(R組).D組先靜脈註射右美託咪啶負荷量1.0 μg/kg,再以0.5 μg·kg-1·h-1的速率靜脈輸註；R組靶控輸註瑞芬太尼,血漿靶濃度3.2ng/m.D組負荷量註射結束、R組達血漿靶濃度時進行氣管插管.氣管插管期間行Ramsay鎮靜評分；評價氣管插管條件和患者對氣管插管的耐受性；記錄氣管插管時間、氣管插管成功情況、氣管插管期間心血管反應、低氧血癥的髮生情況；術後24h迴訪,記錄嚥喉疼痛、聲音嘶啞的髮生情況,記錄患者對氣管插管的滿意度評分和對氣管插管的記憶情況.結果 與R組比較,D組Ramsay鎮靜評分升高,氣管插管條件和耐受性提高,氣管插管時間縮短,氣管插管首次成功率升高,術後滿意度評分升高,不良反應髮生率降低,氣管插管記憶評分降低(P＜0.05).結論 與瑞芬太尼比較,右美託咪啶用于纖維支氣管鏡引導清醒氣管插管時能提供更好的插管條件,不良反應少,且可抑製氣管插管知曉的髮生.
목적 비교우미탁미정여서분태니용우섬유지기관경인도경비청성기관삽관적효과.방법 예기곤난기도택기의행섬유지기관경인도경비청성기관삽관적외과수술환자40례,년령18～73세,ASA분급Ⅰ～Ⅲ급,채용수궤수자표법,장기분위2조(n=20):우미탁미정조(D조)화서분태니조(R조).D조선정맥주사우미탁미정부하량1.0 μg/kg,재이0.5 μg·kg-1·h-1적속솔정맥수주；R조파공수주서분태니,혈장파농도3.2ng/m.D조부하량주사결속、R조체혈장파농도시진행기관삽관.기관삽관기간행Ramsay진정평분；평개기관삽관조건화환자대기관삽관적내수성；기록기관삽관시간、기관삽관성공정황、기관삽관기간심혈관반응、저양혈증적발생정황；술후24h회방,기록인후동통、성음시아적발생정황,기록환자대기관삽관적만의도평분화대기관삽관적기억정황.결과 여R조비교,D조Ramsay진정평분승고,기관삽관조건화내수성제고,기관삽관시간축단,기관삽관수차성공솔승고,술후만의도평분승고,불량반응발생솔강저,기관삽관기억평분강저(P＜0.05).결론 여서분태니비교,우미탁미정용우섬유지기관경인도청성기관삽관시능제공경호적삽관조건,불량반응소,차가억제기관삽관지효적발생.
Objective To compare the efficacy of dexmedetomidine and remifentanil for awake nasotracheal intubation assisted by fiberoptic bronchoscope.Methods Forty ASA Ⅰ -Ⅲ aged 18-73 patients with difficult airways undergoing awake nasotracheal intubation assisted by fiberoptic bronchoscope were randomly divided into 2 groups ( n =20 each): dexmedetomidine group (group D) and remifentanil group (group R).A loading dose of dexmedetomidine 1.0 μg/kg was injected iv and then infused at a rate of 0.5 μg·kg-1 ·h-1 in group D.Remifentanil was target controlled-infused with target plasma concentration of 3.2 ng/ml in group R.Awake nasotracheal intubation was performed after dexmedetomidine loading dose was injected in group D and when the target plasma concentration of remifentanil was reached.Ramsay score was recorded during intubation,and intubation conditions (vocal cord movement,coughing,limb movement) and tolerance (during and after intubation) were evaluated.The intubation time,rate of successful intubation,side effects during intubation and 24 h after surgery,satisfactory score of patient with intubation and memory of intubation were recorded.Results Ramsay score,the first attempt success rates of intubation and satisfactory score of patients with intubation were significantly higher,intubation conditions and tolerance were better,intubation time was shorter,incidence of side effects and memory score of intubation were lower in group D than in group R ( P ＜ 0.05).Conclusion Dexmedetomidine provides better intubation conditions,less side effects and awareness of intubation than remifentanil for awake nasctracheal intubation assisted by fiberoptic bronchoscope.
