右美托咪定联合视可尼喉镜在清醒插管中的应用

摘要

[Objective]To explore the feasibility of dexmcdctomidinc(Dcx) combined Shikani optical stylet (SOS) for relieving patients' pain to complete conscious trachcal intubation. [Methods]Sixty patients undergoing c lcctive operation and general anesthesia of trachcal intubation were randomly divided into two groups. The patients with possible difficult mask ventilation were excluded. All patients were randomly divided into simple local anesthe sia group( Group A, n =30) and Dex plus local anesthesia group (Group B, n =30). The mean arterial pressure (MAP) and heart rate(HR) were recorded at 4 time points including before induction(T0 ), lmin after intubation (T1 ) , 3min after intubation (T2 ) and at immediate time of intubation were recorded. The rate-pressure product (RPP) was calculated. The incidence of nausea, coughing and restlessness were also recorded. Group A was intuba ted consciously with SOS after surface anesthesia. Group B was intubated consciously with SOS after surface anes thesia with Dcx. Sedative, analgesics and muscle reiaxants were intravenously injected after the tube's position was confirmed. Anesthesia was completed by conventional method. [Results]Compared with T0 , MAP, HR and RPP at T1 and T2 in group A were significantly increased ( P <0. 05). MAP, HR and RPP at T1 and T2 showed the up grade trend in group B, but there were no statistical diffcrcnccs( P >0. 05). MAP,HR and RPP at T0 in group A and group B showed no statistical differences, but the above parameters at T1 and T2 in group A were significantly higher than those in group B( P <0. 05). The time of intubation in group A(TiA) was significantly longer than that in group B(TiB)( P<0. 05). The incidence of nausea, coughing and restlessness in group B were significantly lower than those in group A( P <0. 05). [Conclusion]Dex can offer favorable conditions for conscious intubation by use of SOS based on surface anesthesia.%[目的]探索将右美托咪定(Dex)联合视可尼喉镜(SOS)及减轻病人痛苦完成清醒插管的可行性.[方法] 选择择期气管插管全麻手术患者60例,排除可能面罩通气困难的患者,将患者随机分为单纯局麻组(A组,n=30)和Dex加局麻组(B组,n=30).记录入室后诱导前(T0)、插管后1 min(T1)、插管后3 min(T2)三个时间点平均动脉压(MAP)和心率(HR)及插管时间(Ti),计算各点的心率收缩压乘积(rate-pressure product,RPP),并记录插管过程中恶心、呛咳、躁动插管反应的发生情况.A组表麻后行SOS清醒插管,B组先泵入Dex后行表麻,再行SOS清醒插管.确定导管在气管内后静脉给予镇静药、镇痛药和肌松药,常规方法完成麻醉.[结果]与T0比较,A组T1、T2时MAP、HR、RPP明显升高(P＜0.05),B组T1、T2时MAP、HR、RPP有升高趋势,但不具有统计学差异;A组、B组MAP、HR、RPP在T0不具有统计学差异,而T1、T2时A组均明显高于B组(P＜0.05);A组插管时间(TiA)明显长于B组(TiB)(P＜0.05);B组恶心、呛咳、躁动发生率明显低于A组(P＜0.05).[结论]在表面麻醉的基础上,右美托咪定能够为视可尼喉镜清醒插管提供良好条件.