CAJ | 학술논문

目的评价右美托咪定复合地佐辛用于老年患者纤维支气管镜引导清醒气管插管术的辅助效果.方法择期全麻下行外科手术老年患者60例,性别不限,年龄65～77岁,ASA分级Ⅱ或Ⅲ级,Mallampati分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为3组(n=20),地佐辛组(DEZ组)静脉注射地佐辛0.1 mg/kg;右美托咪定组(DEX组)经10～ 15 min静脉输注右美托咪定0.4 μg/kg;地佐辛复合右美托咪定组(DEZ+DEX)经10～ 15 min静脉输注右美托咪定0.4 μg/kg,同时静脉注射地佐辛0.1 mg/kg.给药同时进行常规表面麻醉,给药结束后于纤维支气管镜引导下行清醒气管插管术.记录表面麻醉开始至气管插管后3 min内心血管反应和呼吸抑制的发生情况.记录气管插管时间,评价患者对气管插管的耐受性.于表面麻醉即刻、纤维支气管镜窥视会厌时、气管插管即刻以及气管插管后3 min时记录灌注指数和Ramsay镇静评分,记录镇静满意(Ramsay镇静评分为2～4分)情况.结果与DEZ组或DEX组比较,DEZ+DEX组气管插管耐受性增强,气管插管时间缩短,镇静满意率升高,灌注指数降低,心血管反应发生率降低(P＜0.05);3组呼吸抑制发生率比较差异无统计学意义(P＞0.05)结论与右美托咪定或地佐辛单独应用比较,右美托咪定复合地佐辛用于老年患者纤维支气管镜引导清醒气管插管术时能提供更好的插管条件,且不良反应少.
목적 평개우미탁미정복합지좌신용우노년환자섬유지기관경인도청성기관삽관술적보조효과.방법 택기전마하행외과수술노년환자60례,성별불한,년령65～77세,ASA분급Ⅱ혹Ⅲ급,Mallampati분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위3조(n=20),지좌신조(DEZ조)정맥주사지좌신0.1 mg/kg;우미탁미정조(DEX조)경10～ 15 min정맥수주우미탁미정0.4 μg/kg;지좌신복합우미탁미정조(DEZ+DEX)경10～ 15 min정맥수주우미탁미정0.4 μg/kg,동시정맥주사지좌신0.1 mg/kg.급약동시진행상규표면마취,급약결속후우섬유지기관경인도하행청성기관삽관술.기록표면마취개시지기관삽관후3 min내심혈관반응화호흡억제적발생정황.기록기관삽관시간,평개환자대기관삽관적내수성.우표면마취즉각、섬유지기관경규시회염시、기관삽관즉각이급기관삽관후3 min시기록관주지수화Ramsay진정평분,기록진정만의(Ramsay진정평분위2～4분)정황.결과 여DEZ조혹DEX조비교,DEZ+DEX조기관삽관내수성증강,기관삽관시간축단,진정만의솔승고,관주지수강저,심혈관반응발생솔강저(P＜0.05);3조호흡억제발생솔비교차이무통계학의의(P＞0.05)결론 여우미탁미정혹지좌신단독응용비교,우미탁미정복합지좌신용우노년환자섬유지기관경인도청성기관삽관술시능제공경호적삽관조건,차불량반응소.
Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.