Objective To compare the application effect in patients with acute difficult airway undergoing fiber bronchoscope guided intubation between midazolam and dexmedetomidine. Methods A total of 58 patients with acute difficult airway were selected in Hainan Nada Hospital for Agricultural Reclamation from March 2014 to June 2015,all of them received fiber bronchoscope guided intubation,and they were randomly divided into A group(n = 26)and B group(n = 32). Based on conventional anesthesia,patients of A group received intravenous injection of midazolam within 5 minutes,while patients of B group received intravenous pumping of dexmedetomidine within 10 minutes. Heart rate(HR),mean arterial pressure(MAP), SPO2 ,Ramsay sedation score and tip perfusion index(TPI)at time points before anesthesia(T0 ),before intubation(T1 ), immediately after intubation( T2 ),1 minute after intubation( T3 ),3 minutes after intubation( T4 ) and 5 minutes after intubation(T5 ),noradrenalin(NE),epinephrine(E)and cortisol(Cor)at time points of T0 ,T3 and T5 ,and incidence of adverse reactions were compared between the two groups. Results There was no interaction between time and method in HR, MAP,SPO2 ,Ramsay sedation score or TPI( P > 0. 05);the main effects of time were significant in HR,MAP,SPO2 , Ramsay sedation score and TPI(P < 0. 05);the main effects of method were significant in HR,MAP,SPO2 ,Ramsay sedation score and TPI(P < 0. 05);no statistically significant differences of HR,MAP,SPO2 ,Ramsay sedation score or TPI was found between the two groups at T0 (P > 0. 05);HR of A group was statistically significantly lower than that of B group at T1 (P <0. 05);MAP of A group was statistically significantly lower than that of B group at T3 (P < 0. 05);Ramsay sedation score of A group was statistically significantly lower than that of B group at T2 ,T3 ,T4 and T5 ,respectively(P < 0. 05).There was no interaction between time and method in NE,E or Cor(P > 0. 05);the main effects of time were significant in NE and Cor(P< 0. 05),but was not significant in E(P > 0. 05);the main effects of method were significant in NE and Cor(P < 0. 05), but was not significant in E( P > 0. 05);no statistically significant differences of NE,E or Cor was found between the two groups at T0 (P > 0. 05);NE of A group was statistically significantly higher than that of B group at T3 (P < 0. 05);Cor of A group was statistically significantly higher than that of B group at T3 and T5 ,respectively(P < 0. 05). No statistically significant differences of incidence of adverse reactions was found between the two groups(P > 0. 05). Conclusion Midazolam has better sedative effect than dexmedetomidine in patients with acute difficult airway undergoing fiber bronchoscope guided intubation,can effectively inhibit the stress reaction with less adverse reactions.%目的：比较咪达唑仑与右美托咪定在急性困难气道患者纤维支气管镜（ FOB）插管术中的应用效果。方法选取2014年3月—2015年6月于海南省农垦那大医院行 FOB 插管术的急性困难气道患者58例，随机分为咪达唑仑组26例与右美托咪定组32例。两组患者均予以常规麻醉，咪达唑仑组患者5 min 内静脉推注咪达唑仑，右美托咪定组患者10 min 内静脉泵注右美托咪定。比较两组患者麻醉前（T0）、插管前（T1）、插管即刻（T2）、插管后1 min （T3）、插管后3 min（T4）、插管后5 min（T5）心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）、Ramsay 镇静评分和末梢灌注指数（TPI），T0、T3、T5去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）水平，不良反应发生情况。结果时间与方法在 HR、MAP、SPO2、Ramsay 镇静评分、TPI 上无交互作用（P >0.05）；时间在 HR、MAP、SPO2、Ramsay 镇静评分、TPI 上主效应显著（P <0.05）；方法在 HR、MAP、SPO2、Ramsay 镇静评分、TPI 上主效应显著（P <0.05）；T0两组患者 HR、MAP、SPO2、Ramsay 镇静评分、TPI 比较，差异无统计学意义（P >0.05）；T1咪达唑仑组患者 HR 低于右美托咪定组（P <0.05）；T3咪达唑仑组患者 MAP 低于右美托咪定组（P <0.05）；T2、T3、T4、T5咪达唑仑组患者 Ramsay 镇静评分低于右美托咪定组（P <0.05）。时间与方法在 NE、E、Cor 水平上无交互作用（P >0.05）；时间在 NE、Cor 水平上主效应显著（P <0.05），时间在 E 水平上主效应不显著（P >0.05）；方法在 NE、Cor 水平上主效应显著（P <0.05），方法在 E 水平上主效应不显著（P >0.05）；T0两组患者 NE、E、Cor 水平比较，差异无统计学意义（P >0.05）；T3咪达唑仑组患者 NE 水平高于右美托咪定组（P <0.05）；T3、T5咪达唑仑组患者Cor 水平高于右美托咪定组（P <0.05）。两组患者不良反应发生率比较，差异无统计学意义（P >0.05）。结论咪达唑仑在急性困难气道患者 FOB 插管术中的镇静效果优于右美托咪定，可有效抑制应激反应，且不良反应少。
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