羟考酮联合右美托咪定在纤维支气管镜清醒气管插管中的应用

摘要

Objective To observe the analgesic and sedative effects of oxycodone combined with dexmedetomidine and its effects on respiratory and cardiovascular functions during endotracheal intubation guided by fiberoptic bronchoscope at conscious state.Methods Forty patients with endotra-cheal intubation difficulty were randomly divided into sulfentanil group and oxycodone group.An initial induction dose of 1 μg/kg dexmedetomidine was given followed by an maintaining infusion of 0.2 μg·kg-1 ·h-1 in sulfentanil group,additionally,0.2 μg/kg sulfentanil was given intravenously. Patients in oxycodone group received intravenous infusion of oxycodone 0.08 mg/kg instead.The changes of HR,MAP and SpO 2 were monitored during medication and intubation.The Ramsay scores before intubation, the PET CO 2 and comfort degree after intubation were recorded. Results There were no statistically significant differences in hemodynamic changes,Ramsay scores and comfort level between the two groups during drug-injection and intubation.SpO 2 of patients in oxycodone group was higher than that of sulfentanil group after injection of drugs,but PET CO 2 of oxycodone group after endotracheal intubation was lower.Conclusion The combination of oxycodone and dexmedetomidine can be safely used in awake tracheal intubation,for it shows effective sedation and analgesia,less respiratory depression and other side-effects compared with sufentanil.%目的：观察羟考酮复合右美托咪定在清醒气管插管中的镇痛镇静效果以及对呼吸和循环功能的影响。方法选择术前预计困难气道的择期手术患者40例,随机分为舒芬太尼组和羟考酮组。两组患者静脉泵注右美托咪定1μg/kg 后以0.2μg·kg-1·h-1维持,舒芬太尼组静注舒芬太尼0.2μg/kg,羟考酮组静注羟考酮0.08 mg/kg。监测患者用药及插管期间 HR、MAP 和 SpO 2变化,并记录插管前 Ramsay 评分以及插管后PET CO 2和舒适度评分。结果两组患者用药及插管期间的血流动力学变化、镇静及舒适度差异无统计学意义。羟考酮组患者静注后 SpO 2明显高于舒芬太尼组(P <0.05),气管插管后PET CO 2明显降低(P <0.05)。结论羟考酮复合右美托咪定可安全地用于清醒气管插管,镇痛、镇静效果良好,与舒芬太尼相比,呼吸抑制轻,不良反应少。