盐酸右美托咪定用于清醒气管插管患者围拔管期的临床研究

摘要

目的：探讨盐酸右美托咪定用于清醒气管插管患者围拔管期的临床效果。方法将60例准备拔除气管插管的清醒患者按随机数字表法分成观察组和对照组，每组30例。2组患者在拔除气管插管前，行2 min及30 min自主呼吸试验均为阴性，观察组微量泵静脉注射盐酸右美托咪定1μg· kg-1，注射时间为10 min；对照组静脉注射生理盐水10 mL，注射时间为10 min。2组均在用药后10 min拔除气管插管，拔管后面罩给氧10 min，再转为鼻导管给氧，氧流量为4～6 L·min-1。观察2组患者拔管前（T0）、拔管即刻（T1）、拔管后10 min（T2）、拔管后30 min （T3）及拔管后1 h（T4）各时间点心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、血氧饱和度（SpO2）及氧合指数（PaO2/FiO2）等指标的变化，并统计24 h内拔管成功率。结果2组患者 T1、T2、T3及 T4的 MAP、HR、RR 及SpO2均高于T0（均P＜0．05）。观察组 T1、T2、T3的 MAP、HR、RR均低于对照组，SpO2及 T3、T4的 PaO2/FiO2均高于对照组（均P＜0．05）。对照组24 h内拔管成功率为86．7％，观察组24 h内拔管成功率为100．0％。2组比较差异有统计学意义（P＜0．05）。结论清醒气管插管患者围拔管期使用右美托咪定，能有效地抑制拔管反应，保持拔管前后呼吸和动力学的稳定。%Objective To explore the clinical efficacy of dexmedetomidine hydrochloride in the peri-extubation period in patients receiving awake endotracheal intubation.Methods Sixty awake patients who were ready for tracheal extubation were randomly divided into observation group and control group,with 30 patients in each group.The 2-and 30-minute spontaneous breathing trials showed negative results in all patients before tracheal extubation.The observation group was giv-en 10 minutes of intravenous injection of dexmedetomidine hydrochloride(1μg·kg-1)with micro pump.The control group was given 10 minutes of intravenous injection of normal saline(10 mL). Tracheal extubation was performed 10 minutes after intravenous injection.After extubation,pa-tients were given oxygen inhalation with face masks for 10 minutes,followed by oxygen inhalation with nasal catheters with a oxygen flow rate of 4-6 L· min-1 .Heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),oxygen saturation(SpO2 ),oxygenation index(PaO2/FiO2 ) and other indicators were determined before extubation(T0 ),immediately after extubation(T1 ), 10 minutes after extubation(T2 ),30 minutes after extubation(T3 )and 1 hour after extubation (T4 ).Furthermore,the extubation success rates within 24 hours were calculated.Results Com-pared with T0 ,MAP,HR,RR and SpO2 significantly increased at T1 ,T2 ,T3 and T4 (all P<0.05).Compared with control group,MAP,HR and RR at T1 ,T2 and T3 and PaO2/FiO2 ratio at T3 and T4 obviously decreased,but SpO2 at all time points markedly increased in observation group (all P<0.05).In addition,the extubation success rate within 24 hours in observation group was significantly higher than that in control group(100.0% vs 86.7%,P<0.05).Conclusion The application of dexmedetomidine hydrochloride in the peri-extubation period can effectively inhibit the extubation reaction and keep respiratory and dynamic stability before and after extubation in patients receiving awake endotracheal intubation.