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右美托咪啶在急诊饱胃病人清醒气管插管中的应用
Application of Dexmedetomidine for Conscious Intubation in Emergency Patients with Full Stomach
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DOI:
作者:
王颖, 陈懿, 周振锋, 于静
WANG Ying CHEN Yi ZHOU Zhen-feng YU Jing
作者单位:
浙江省天台县妇幼保健所药剂科
Department of Pharmacy, Women and Children Health Hospital of Taizhou Tiantai
关键词:
右美托咪啶 气管插管 镇静 喉镜检查
dexmedetomidine; awake intubation; sedative; laryngoscopy
摘要:
【摘要】目的:探讨急诊饱胃病人咽腔表面麻醉和经环甲膜穿刺气管内表面麻醉下右美托咪啶在普通喉镜下清醒气管插管中的应用。方法:急诊行腹腔镜下胃穿孔修补手术病人52例,随机分为右美托咪啶组(D组)和芬太尼组(F组),每组26例分别给予1 µg/kg右美托咪啶和芬太尼,10min 静脉泵注完毕,,应用2%的利多卡因进行咽腔的表面麻醉和经环甲膜穿刺注药行气管内表面麻醉,随后开始普通喉镜下气管插管记录入室后诱导前(T1)、药物泵注结束即刻(T2)和插管成功即刻(T3)3个时点的心率(HR)、平均动脉压(MAP)、脉搏血氧饱度(SpO2)及Ramsay镇静评分。比较二组的插管耐受度、满意度评分和插管过程中恶心、呛咳、躁动等插管反应的发生情况。结果:组内各时刻MAP、HR、Ramsay的比较:与本组T1比较,两组给药后(T2)HR均降低(P<0.05),D组T2、T3 (插管后即刻)时点Ramsay镇静评分升高(P<0.05),而F组无显著差异(P>0.05)。组间各时刻MAP、HR、Ramsay的比较:与F组比较,D组T2时点HR降低(P<0.05),T3时点MAP、HR均降低(P<0.05);D组T2、T3时点的Ramsay镇静评分高于F组,差异有统计学意义(P<0.05)。二组均未出现需处理的HR、BP、SpO2下降,D组插管耐受度和满意度评分及恶心、呛咳、躁动等插管反应的发生情况均优于F组(P<0.05)。 结论:右美托咪啶应用于急诊饱胃病人清醒状态下气管插管,具有镇静效果佳、插管耐受性好、无呼吸抑制、血流动力学更稳定以及不良反应少的优势。
【Abstract】 Objective To explore the application of Dexmedetomidine (Dex) for Conscious Tracheal Intubation in Emergency Patients with Full Stomach by common laryngoscopy based on surface anesthesia. Methods Fifty two emergency patients were undergoing laparoscopic repair of perforated peptic ulcer and they were randomly divided into Dexmedetomidine group (group D) and fentanyl group (group F), there were 26 patients in each group. They received Dexmedetomidine or fentanyl at loading of dose 1 µg/kg for 10 minutes. Patients in the two groups were received enough topical anesthetics to the airway, then awake common intubation was administered. The heart rate(HR), mean artery pressure(MAP), blood oxygen saturation of pulse(SpO2) and Ramsay sedation scores were recorded at 3 time points including before induction(T1) , immediate time of finishing drug infusion(T2), immediate time of successful intubation(T3). To compare the intubation tolerance , satisfaction scores, the incidence of nausea,coughing and restlessness between the two groups. Results Compared with T1, HR at T2 in each group were significantly lower(P<0.05) and Ramsay sedation scores at T2 and T3 in group D were significantly higher (P<0.05), there was no significant variations in the group F(P>0.05)。While compared with group F, MAP and HR at T3 was significantly lower(P<0.05) , HR at T2 was also lower(P<0.05), and Ramsay sedation scores at T2 and T3 was significantly higher (P<0.05) in group D。There was no HR ,BP or SpO2 depression that needed to be managed in the two groups . The intubation tolerance , satisfaction scores and the incidence of nausea, coughing and restlessness in group D were significantly better than those in group F (P<0.05). Conclusion When application of dexmedetomidine for conscious intubation in emergency patients with full stomach, dexmedetomidine has several advantages including desirable sedation, well toleration of intubation, no respiratory depression, hemodynamic stability and less adverse reaction.
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