中国实用医药
中國實用醫藥
중국실용의약
CHINA PRACTICAL MEDICAL
2015年
5期
5-7
,共3页
秦树国%陈文丽%赵明%哈斯
秦樹國%陳文麗%趙明%哈斯
진수국%진문려%조명%합사
右美托咪定%瑞芬太尼%鼻腔%清醒气管插管%阻塞性睡眠呼吸暂停综合征
右美託咪定%瑞芬太尼%鼻腔%清醒氣管插管%阻塞性睡眠呼吸暫停綜閤徵
우미탁미정%서분태니%비강%청성기관삽관%조새성수면호흡잠정종합정
Dexmedetomidine%Remifentanil%Nasal cavity%Conscious endotracheal intubation%Obstructive sleep apnea syndrome
目的：探讨瑞芬太尼配合光纤喉镜下经鼻腔清醒气管插管用于悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征(OSAS)的效果。方法80例OSAS患者，随机分为两组，每组40例。右美托咪定组(D组)、右美托咪定加瑞芬太尼组(DR组)。两组均静脉输注右美托咪定(DEX)， DR组缓慢加静脉滴注瑞芬太尼。记录插管即刻(T1)、插管后5 min(T2)、插管后10 min(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)，插管完成时间及插管次数，有无呛咳及不良回忆、躁动、呼吸抑制等麻醉慢诱导不良反应。结果两组T1、T2、T3时的MAP、HR比较， DR组显著低于D组，差异具有统计学意义(P<0.05)。两组呛咳、不良回忆、躁动比较，差异具有统计学意义(P<0.05)。结论在右美托咪定的基础上加用瑞芬太尼，可完善经鼻清醒气管插管镇静、镇痛的效果，不抑制呼吸，血流动力学平稳，应激反应轻，可提供良好的气管插管条件，适用于阻塞性睡眠呼吸暂停综合征的临床治疗。
目的：探討瑞芬太尼配閤光纖喉鏡下經鼻腔清醒氣管插管用于懸雍垂腭嚥成形術治療阻塞性睡眠呼吸暫停綜閤徵(OSAS)的效果。方法80例OSAS患者，隨機分為兩組，每組40例。右美託咪定組(D組)、右美託咪定加瑞芬太尼組(DR組)。兩組均靜脈輸註右美託咪定(DEX)， DR組緩慢加靜脈滴註瑞芬太尼。記錄插管即刻(T1)、插管後5 min(T2)、插管後10 min(T3)的平均動脈壓(MAP)、心率(HR)、血氧飽和度(SpO2)，插管完成時間及插管次數，有無嗆咳及不良迴憶、躁動、呼吸抑製等痳醉慢誘導不良反應。結果兩組T1、T2、T3時的MAP、HR比較， DR組顯著低于D組，差異具有統計學意義(P<0.05)。兩組嗆咳、不良迴憶、躁動比較，差異具有統計學意義(P<0.05)。結論在右美託咪定的基礎上加用瑞芬太尼，可完善經鼻清醒氣管插管鎮靜、鎮痛的效果，不抑製呼吸，血流動力學平穩，應激反應輕，可提供良好的氣管插管條件，適用于阻塞性睡眠呼吸暫停綜閤徵的臨床治療。
목적：탐토서분태니배합광섬후경하경비강청성기관삽관용우현옹수악인성형술치료조새성수면호흡잠정종합정(OSAS)적효과。방법80례OSAS환자，수궤분위량조，매조40례。우미탁미정조(D조)、우미탁미정가서분태니조(DR조)。량조균정맥수주우미탁미정(DEX)， DR조완만가정맥적주서분태니。기록삽관즉각(T1)、삽관후5 min(T2)、삽관후10 min(T3)적평균동맥압(MAP)、심솔(HR)、혈양포화도(SpO2)，삽관완성시간급삽관차수，유무창해급불량회억、조동、호흡억제등마취만유도불량반응。결과량조T1、T2、T3시적MAP、HR비교， DR조현저저우D조，차이구유통계학의의(P<0.05)。량조창해、불량회억、조동비교，차이구유통계학의의(P<0.05)。결론재우미탁미정적기출상가용서분태니，가완선경비청성기관삽관진정、진통적효과，불억제호흡，혈류동역학평은，응격반응경，가제공량호적기관삽관조건，괄용우조새성수면호흡잠정종합정적림상치료。
Objective To investigate the effect of remifentanil combined with fiber laryngoscope through nasal cavity conscious endotracheal intubation for obstructive sleep apnea syndrome (OSAS) treated by uvulopalatopharyngoplasty. Methods A total of 80 OSAS patients were randomly divided into two group with 40 cases in each group as dexmedetomidine group (group D) and dexmedetomidine plus remifentanil group (group DR). Both groups received intravenous injection of dexmedetomidine (DEX), and the group DR was given slow intravenous drip of remifentanil. Mean arterial pressure (MAP), heart rate (HR) and oxyhemoglobin saturation (SpO2)were recorded at intubation (T1), 5 min after intubation (T2), and 10 min after intubation (T3). Records were also made on intubation completion time, intubation times, cough and bad memories, restlessness, respiratory inhibition of slow anesthesia induced adverse reaction. Results Compared with group D, group DR had much lower levels of MAP and HR in T1, T2, and T3. The difference had statistical significance (P<0.05). The difference of adverse reactions of cough and bad memories, and restlessness had statistical significance between the two groups (P<0.05). Conclusion Additional implement of remifentanil on the basis of dexmedetomidine can improve sedation and analgesia effects of conscious endotracheal intubation through nasal cavity without inhibiting breath. It has stable haemodynamics and slight stress reaction, and can good condition for endotracheal intubation. This method is suitable for clinical treatment of obstructive sleep apnea syndrome.
