右旋美托咪定联合纤维支气管镜进行气管插管在巨大甲状腺肿所致困难气道中的应用

目的: 探讨在巨大甲状腺肿所致的困难气道中应用右旋美托咪定联合纤维支气管镜进行气管插管的有效性。方法: 选择巨大甲状腺肿致气管受压移位或变形患者30例, 采用计算机随机分为右旋美托咪定组(n = 15) 和丙泊酚组(n = 15) 。右旋美托咪定组先给予负荷剂量右旋美托咪定1. 0μg·kg 1, 输注超过10 mi n后以0. 4μg·kg 1·h 1持续泵人。丙泊酚组先缓慢给予丙泊酚2. 0 mg·kg 1, 后以5 ～8 mg·kg 1·h 1持续泵人。对插管条件进行评估分级; 观察患者在插管过程中的反应, 如咳嗽分级和患者插管时的舒适度; 记录麻醉前(T0) 、Rassay评分为4时(T1) 、气管插管时(T2) 、插管后1 mi n(T3) 及插管后3 mi n(T4)5个时间点的心率和血压的变化; 记录阿托品和多巴胺的用量以及低氧血症和呼吸抑制等。结果:2组均成功完成纤维支气管镜下气管插管。右旋美托咪定组患者在插管过程中保持良好的自主呼吸, 无气道梗阻发生, 均能按照指令配合气管插管。丙泊酚组有6例(40. 0 %) 患者出现呼吸道梗阻,11例(73. 3 %) 不能按指令配合气管插管,2组比较差异有统计学意义(P ＜0. 05) 。右旋美托咪定组有12例声门开放,3例声门活动; 丙泊酚组有7例声门开放,6例声门活动; 右旋美托咪定组较丙泊酚组提供较好的插管条件(P ＜0. 05) 。在整个插管过程中没有反应或只是轻微的面部表情者, 右旋美托咪定组有12例, 丙泊酚组有8例,2组比较差异有统计学意义(P ＜0. 05) 。右旋美托咪定组患者在T1和T2时刻心率下降更为明显。插管后T3、T4时刻2组患者心率均加快, 但右旋美托咪定组患者心率加快不显著, 与丙泊酚组比较差异有统计学意义(P ＜0. 05) 。在插管过程中右旋美托咪定组未出现低氧血症和气道梗阻, 而丙泊酚组3例出现低氧血症,6例出现气道梗阻,2组比较差异有统计学有意义(P ＜0. 05) 。结论: 在处理巨大甲状腺肿所致的困难气道时, 与丙泊酚比较, 右旋美托咪定耐受性好, 患者呼吸通畅, 插管时血流动力学稳定。

Appli cati on of dex medet o mi di ne co mbi ned wit h fi br eopti cbr onchoscope f or t r acheal i nt ubati on i n diffi cult ai r wayscaused by huge goit er

Obj e cti ve To st udy t he effecti veness of dex medet o mi di ne co mbi ned wit h fi br eoptic br onchoscope f ort r acheal i nt ubati on i n difficult air ways caused by huge goit er . Met hods Thirt y pati ent s wit h difficult air wayscaused by huge goit er wer e enr oll ed and r ando ml y di vi ded i nt o dex medet o mi di ne gr oup(n = 15)and pr opof ol gr oup(n = 15). The pati ent s i n dex medet o mi di ne gr oup r ecei ved a l oadi ng dose of dex medet o mi di ne(1. 0μg·kg 1) ,i nf used over 10 mi n,t hen pu mped at conti nuous r at e of 0. 4μg·kg 1·h 1. The pati ent s i n pr opof ol gr oupr ecei ved a l oadi ng dose of 2. 0 mg·kg 1and pu mped at conti nuous r at e of 5 8 mg·kg 1·h 1. The i nt ubati ngconditi ons wer e gr aded by a scori ng s yst e m;t he r eacti ons t o i nt ubati on s uch as coughi ng and pati ent t ol er ance wer eobser ved;t he heart r at es and mean art eri al bl ood pr ess ur es(MABP)at diff er ent ti me poi nt s of baseli ne(T0) ,Rassay scor e 4(T1) ,i nt ubati ng(T2) ,1 mi n aft er i nt ubati on(T3)and 3 mi n aft er i nt ubati on(T4)wer e r ecor ded;adver se event s and hae modyna mic s upport wer e obser ved . Result s All t he pati ent s i n t wo gr oups wer e perf or meds uccessf ull y wit h fi br eoptic i nt ubati on. The pati ent s i n dex medet o mi di ne gr oup coul d keep bet t er s pont aneousbr eat hi ng wit hout r es pir at or y depr essi on,and wer e abl e t o co mmand and cooper at e t r acheal i nt ubati on,whil e i npr opof ol gr oup 11 pati ent s(73. 3 %)coul d not cooper at e t r acheal i nt ubati on(P ＜0. 05). Wit h r es pect t o i nt ubati onscor es i n pr opof ol gr oup,t her e wer e 7 cases of vocal cor d openi ng and 3 cases of vocal cor d move ment;whil e i ndex medet o mi di ne gr oup,t her e wer e 12 cases i n vocal cor d openi ng and 3 cases i n vocal cor d movi ng . Co mpar edwit h pr opof ol gr oup,t he pati ent s i n dex medet o mi di ne gr oup had mor e f avor abl e i nt ubati on scor es of vocal cor dmove ment(P ＜0. 05). Wit h r es pect t o no r eacti on or sli ght gri maci ng of r eacti on t o i nt ubati on co mf ort scor e,t her e wer e 8 cases i n pr opof ol gr oup and 12 cases i n dex medet o mi di ne gr oup,and t her e was si gnifi cant diff er ence(P＜0. 05). The pati ent s i n dex medet o mi di ne gr oup experi enced fe wer air way event s and l ess heart r at e r es ponse t oi nt ubati on t han t hose i n pr opof ol gr oup(P ＜0. 05). Conclusi on Co mpar ed wit h pr o pof ol i n mana ge ment of difficultair ways caused by huge goit er,dex medet o mi di ne has bet t er t ol er ance,and pr eser ves a pati ent air way,and hasmor e st abl e hae modyna mic r es ponse t o i nt ubati on .