目的 研究右美托咪定复合利多卡因雾化吸入对经鼻清醒气管插管反应的影响。方法 选择90例需行纤维支气管镜引导下经鼻清醒气管插管患者,年龄18~60岁,ASA 分级Ⅰ~Ⅱ级。随机分为右美托咪定组(D组)、利多卡因雾化吸入组(L组)、右美托咪定复合利多卡因雾化吸入组(DL组),每组30例。D组经静脉泵注右美托咪定1.0 μg/kg;L组采用利多卡因5 mg/kg雾化吸入表面麻醉;DL组经静脉泵注右美托咪定1.0 μg/kg复合利多卡因5 mg/kg雾化吸入表面麻醉。分别记录插管条件与患者舒适度评分,基础值(T0)、插管前(T1)、插管开始(T2)、插入气管即刻时(T3)的HR、MAP 变化及呛咳、恶心、躁动等不良反应,术后随访患者对插管情形的回忆情况。结果 3组插管时间对比差异无统计学意义, DL组与D组、L组比较,插管条件与患者舒适度较好,差异有统计学意义(P＜0.05); DL组与D组、L组比较,DL组在T2、T3的HR[(75±12) 次/min、 (76±13) 次/min]、MAP[(76±27) mmHg、 (74±23) mmHg]明显降低,差异有统计学意义(P＜0.05),但与4个时间点相比,变化不大,差异无统计学意义。L组有8例(27%)出现轻度呛咳,D组有6例(20%)出现轻度呛咳,但均不影响操作,与D组、L组比较,DL组呛咳仅有1例,发生率较低,3组比较差异有统计学意义(P＜0.05)。结论 右美托咪定复合利多卡因雾化吸入能较好地抑制经鼻清醒气管插管的反应,且不良反应少,适合临床应用。
Abstract
Objective To study the effect of dexmedetomidine combined with nebulized lidocaine inhalation on conscious patients receiving nasotracheal intubation. Methods Ninty conscious patients needing nasotracheal intubation,ASA physical Ⅰ orⅡ,aged 18-60 yr,were randomly divided into three groups (n=30):group D,group L and groupDL.The patients in group D were intravenously administered 1.0 μg/kg dexmedetomidine.The patients in group L inhalated nebulized lidocaine 5 mg/kg.The patients in group DL were intravenously administered 1.0 μg/kg dexmedetomidine combined with nebulized lidocaine 5 mg/kg. Intubation conditions, comfort scores, MAP and HR of basis(T0) ,before the intubation(T1), beginning of the intubation(T2), insertion into the trachea immediately(T3) and adverse reactions, such as cough, nausea, restless were recorded. The petients were followed up for the memories of intubation after operation. Results Compared with group DL, the intubation conditions and comfort scores were significantly poor in group D and group L. Compared with T0 and T1, MAP and HR in group D and group L significantly increased at T2 and T3. Compared with group DL, MAP and HR in group D and group L significantly increased at T2 and T3. Compared with group D and group DL, the incidence of memory of intubation significantly increased in group L. Conclusions Dexmedetomidine combined with nebulized lidocaine inhalation can inhibit the response of conscious patient receiving nasotracheal intubation.
关键词
困难气道 /
右美托咪定 /
利多卡因 /
清醒气管插管 /
插管反应
Key words
difficult airway /
dexmedetomidine /
lidocaine /
conscious intubation /
response to intubation
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参考文献
[1] 向 璟.HC视频喉镜与Macintosh喉镜引导麻醉气管插管的效果比较[J].武警医学,2014,26(12):1193-1195.
[2] Shimabukuro A, Satoh K. Airway management with dexmedetomidine for difficult airway. Masui[J]. Anaesthesia, 2007,56(6):681-684.
[3] 范慧慧,范莹盈,徐 浩,等.右美托咪啶用于颌面外科手术清醒纤维支气管镜插管镇静的临床研究[J].实用口腔学杂志,2012,28(2):223-225.
[4] 柳垂亮,李玉娟,龚文魁,等.右美托咪定用于Shikani喉镜引导颈椎手术清醒气管插管的研究[J]. 国际麻醉学与复苏杂志, 2013,34 (4):293-295.
[5] 滕永杰,李 军,上官王宁,等.利多卡因雾化吸入用于纤维支气镜引导清醒气管插管患者的效果观察 [J] . 临床麻醉学杂志,2011,27 (4):346-348.
[6] Tsaicj, Chucks,Chenti,et al.A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreopticnasotracheal intubation[J]. Anaesthesia,2010,65(3):254-259.
[7] Raimr, Parrytm,Dombrovskisa,et al.Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation:a double-blinded randomized controlled trial[J].Br J Anaesth,2008,100(1):125-130 .
[8] 龙浴辉,胡建军,钟伟强,等. 右旋美托咪啶在清醒镇静纤维支气管镜引导困难气道气管内插管中的应用[J].广东医学,2011,32(17):2287-2288.
[9] 李 荣,方 明,张中军.右美托咪定配合表面麻醉在困难气道插管中的应用[J].江苏医药, 2011,37(18):2306-2307.
[10] 方 明,李 荣,张中军,等.气道黏膜序贯式表面麻醉的清醒气管插管效果[J].江苏医药,2010,36(23):2753-2754.
[11] Madhere M, Vangura D, Saidov A. Dexmedetomidine as sole agent for awake fiberoptic intubation in a patient with local anesthetic allergy[J]. Anesth, 2011, 25(4): 592-594.
[12] 葛亚丽,郭松青,李 倩,等.不同剂量右美托咪定用于高血压患者清醒气管插管的效果[J].临床麻醉学杂志,2013,29 (4):381-383.
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