CAJ | 학술논문

目的：探讨不同剂量右美托咪定复合靶控瑞芬太尼在成人清醒气管插管中的应用。方法选取2011年3月至2013年3月行全麻手术患者36例，随机分为第一组、第二组和第三组，每组各12例。所有患者口腔、咽喉部表面麻醉后，静脉泵注0.8μg/kg右美托咪定的负荷剂量，第一组患者以0.25μg/（ k·h）作为维持剂量，第二组患者以0.5μg/（k·h）作为维持剂量，第三组患者以1.0μg/（k·h）作为维持剂量。同时靶控输注瑞芬太尼4 ng/ml。当脑电双频指数（ BIS）值小于55时，行气管插管。记录麻醉前（ T0）、插管前即刻（ T1）、插管完成后1 min（ T2）、插管完成后5 min （ T3）的平均动脉压（ MAP）、血氧饱和度（ SpO2）、心率和BIS变化。观察插管前后心动过缓、呛咳、呼吸抑制和恶心的发生情况。结果各组患者MAP先下降后上升，且第三组患者T2、T3时间点MAP与同组T0时间点比较明显升高，差异具有统计学意义（ P <0.05）；第三组患者T1、T2、T3时间点SpO2下降明显，与T0时间点比较，差异具有统计学意义（ P<0.05）；各组患者心率先下降后上升，BIS都出现不同程度的降低，第二组、第三组患者T2、T3时间点HR和BIS与同时间点的第一组比较明显降低，差异具有统计学意义（ P <0.05）；第三组患者心动过缓和呼吸抑制的发生率明显高于第一和第二组，差异具有统计学意义（ P <0.05）。结论0.5μg/（ k·h）作为维持剂量的右美托咪定复合靶控瑞芬太尼对成人清醒气管插管具有很好的麻醉效果，能获得稳定的血流动力学，且不良反应发生率低。
목적：탐토불동제량우미탁미정복합파공서분태니재성인청성기관삽관중적응용。방법선취2011년3월지2013년3월행전마수술환자36례，수궤분위제일조、제이조화제삼조，매조각12례。소유환자구강、인후부표면마취후，정맥빙주0.8μg/kg우미탁미정적부하제량，제일조환자이0.25μg/（ k·h）작위유지제량，제이조환자이0.5μg/（k·h）작위유지제량，제삼조환자이1.0μg/（k·h）작위유지제량。동시파공수주서분태니4 ng/ml。당뇌전쌍빈지수（ BIS）치소우55시，행기관삽관。기록마취전（ T0）、삽관전즉각（ T1）、삽관완성후1 min（ T2）、삽관완성후5 min （ T3）적평균동맥압（ MAP）、혈양포화도（ SpO2）、심솔화BIS변화。관찰삽관전후심동과완、창해、호흡억제화악심적발생정황。결과각조환자MAP선하강후상승，차제삼조환자T2、T3시간점MAP여동조T0시간점비교명현승고，차이구유통계학의의（ P <0.05）；제삼조환자T1、T2、T3시간점SpO2하강명현，여T0시간점비교，차이구유통계학의의（ P<0.05）；각조환자심솔선하강후상승，BIS도출현불동정도적강저，제이조、제삼조환자T2、T3시간점HR화BIS여동시간점적제일조비교명현강저，차이구유통계학의의（ P <0.05）；제삼조환자심동과완화호흡억제적발생솔명현고우제일화제이조，차이구유통계학의의（ P <0.05）。결론0.5μg/（ k·h）작위유지제량적우미탁미정복합파공서분태니대성인청성기관삽관구유흔호적마취효과，능획득은정적혈류동역학，차불량반응발생솔저。
Objective To investigate different doses of dexmedetomidine given composite target-controlled remifentanil in adult awake tracheal intubation. Methods Between March 2011 and March 2013 in our hospital,anesthesia 36 patients were randomly divided into the first group,the second group and the third group,12 cases were included in each group. All patients were given surface anesthesia in the mouth, throat. The intravenous infusion 0. 8 μg/kg of dexmedetomidine was given a loading dose. The first group of patients was given with 0. 25 μg/(k ·h)as a maintenance dose. The second group patients was given with 0. 5 μg/(k·h)as a maintenance dose. The third group of patients was given 1. 0μg/(k·h)as a maintenance dose. Meanwhile target-controlled infusion of remifentanil 4 ng/ml. When BIS values were less than 55. These patients were given endotracheal intubation. Anesthesia condition before( T0 ),before intubation( T1 ),intubation 1 min( T2 ),5min ( T3 )of MAP,SpO2 ,heart rate and changes in BIS after intubation were recorded. The before and after intubation bradycardia,cough,respirato-ry depression and nausea occurrence were recorded. Results The patients in each group after the first decline in MAP increased. The third group of patients with T2 ,T3 was compared T0 time point with the same point in time MAP group. The difference was statistically significant( P <0. 05). The third group of patients with T1 ,T2 ,T3 time SpO2 decreased significantly compared with T0 time point. The difference was statistically significant( P <0. 05). The increase of each group took the lead after cardiac decline. BIS showed varying degree of reduction. The second group,the third group of patients T2 ,HR and BIS T3 time points were compared with the same time the first set point,which showed a significant difference( P <0. 05). The incidence of bradycardia and respiratory depression third group of patients was significantly higher than that of the first and second group( P <0. 05 ). Conclusion 0. 5 μg/(k·h)as a maintenance dose of dexmedetomidine can give composite target-con-trolled remifentanil awake tracheal intubation in adults. This method showed good anesthetic effect,and can get a stable hemodynamic and low in-cidence of adverse reactions.