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右美托咪定对困难气道盲探气管插管应激反应的影响
Effect of dexmedetomidine on stress reaction in difficult airway patients with blind tracheal intubation
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DOI:
作者:
习建华 邓芳 王丽华 叶雯
XI Jianhua, DENG Fang, WANG Lihua, YE Wen.
作者单位:
杭州市第一人民医院麻醉科
XI Jianhua, DENG Fang, WANG Lihua, YE Wen. Department of Anesthesiology, First people’s hospital of HangZhou, Zhejiang 310006, China
关键词:
右美托咪定;经鼻气管插管;盲探气管插管装置;应激反应
Dexmedetomidine; nasotracheal intubation; blind intubation device; stress reaction
摘要:
目的 研究右美托咪定复合表麻对保留自主呼吸患者经鼻盲探气管插管应激反应的影响。方法 将46例需经鼻气管插管患者随机分为右美托咪定组(D组)和咪达唑仑复合芬太尼组(M组),每组23例。两组均先使咽喉、气管充分表麻。右美托咪定组于插管前10min静脉泵入1μg/kg右美托咪定,后以0.5μg/kg/h持续泵注。咪达唑仑组于插管前5min静脉注射30μg/kg的咪达唑仑及1μg/kg的芬太尼。再应用盲探气管插管装置对患者进行经鼻气管插管,观察两组的插管成功率,插管时间。于两组注药前基础值(T0),光索置入气道后即刻(T1),经光索引导气管插管置入气管后30秒(T2)观察HR、SBP、SpO2变化,抽血测血浆皮质醇浓度,血糖浓度及镇静评分(OAA/S评分)。结果 两组间性别构成、年龄及体重指数的差异均无统计学意义。两组间的插管成功率及插管时间差异无统计学意义(P值均>0.05)。D组患者皮质醇浓度在T1及T2时间点都低于M组,差异有显著性(其中T1时P<0.05,T2时P<0.01);M组血糖浓度及HR、SBP在T1及T2时间点显著高于D组,差异显著(P均<0.01);D组在T1时间点OAA/S评分比M组有显著差异(P<0.01),在T2时间点比M组也有差异(P<0.05)。整个气管插管过程中,两组患者SpO2均维持在95%以上。结论 右美托咪定复合表麻下的盲探气管插管装置经鼻气管插管的患者应激反应更少,镇静程度更理想,保证了插管期患者安全舒适。
Objective To research the effect of dexmedetomidine complxing topical anesthesia on stress reaction in Spontaneous breathing patients receiving nasotracheal intubation with blind intubation device . Methods 46 patients receiving nasotracheal intubation were divided into dexmedetomidine group(group D) and midazolam-fentanyl group(group M), 23 patients in each group(n=23). Each patient was exacuted by topical anesthesia in throat and trachea. The patients in group D received intravenous injection of 1μg/kg dexmedetomidine for 10 mins and followed continued injection of 0.5μg•kg-1•h-1 dexmedetomidine. The patients in group M received of 30μg/kg midazolam and 1μg/kg fentanyl at 5 mins before intubation. All patients were implemented by awake nasotracheal intubation with blind intubation device and recorded the success rates of intubation and intubation time. HR 、SBP、SpO2 of all patients were observed at the time of before-medication (T0), immediately after inserting lightwand(T1) and 30 seconds after inserting the endotracheal tube(T2). Concentration of cortisol and blood sugar, observe’s assessment of alertness/sedation(OAA/S) were detected at T1 T2.. Results There were no significant differences in age, gender, body mass inder(BMI), success rates of intubation or intubation time between the two groups(P>0.05). Concentration of cortisol was significantly lower in group D than group M at T1 T2.( T1:P<0.05, T2:P <0.01). Concentration of blood sugar and HR 、SBP was significantly higher in group M than group D at T1 T2( P <0.01). OAA/S score was significantly lower in group D than group M at T1 T2.( T1:P<0.01, T2:P <0.05). SpO2 was upper 95% in both two groups during intubation. Conclusion Stress reaction of the patients were lower in Spontaneous breathing patients receiving nasotracheal intubation with blind intubation device under maintaining dexmedetomidine complexing topical anesthesia, and patients retained better calm. So the patients were more safe and comfortable.
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