地佐辛联合不同剂量右美托咪定用于OSAHS患者经鼻清醒插管的效果比较

目的　观察地佐辛联合不同剂量右美托咪啶用于阻塞性睡眠呼吸低通气暂停综合征（OSAHS）患者行纤维支气管镜引导经鼻清醒气管插管（AFNI）的效果。方法　OSAHS患者80例按随机数字表法分为地佐辛0.1 mg/kg组（C组）、地佐辛0.1 mg/kg+右美托咪定（DEX）0.5 µg/kg组（D1组），地佐辛0.1 mg/kg+DEX 1 µg/kg组（D2组），地佐辛0.1 mg/kg+DEX 1.5 µg/kg组（D3组），每组20例。在给予全部患者静脉注射地佐辛0.1 mg/kg的同时，C组静脉泵注0.5 µg/kg生理盐水，D1、D2、D3组分别静脉泵注DEX 0.5、1、1.5 µg/kg（10 min泵完）。气管插管前5 min行鼻腔咽喉表面麻醉，药泵注结束行AFNI。比较4组入室时（T0）、插管前（T1）和插管后（T2）心率（HR）、平均动脉压（MAP）、血氧饱和度（SPO2）、脑电双频指数（BIS）值和Ramsay镇静评分、插管耐受度、插管时间、患者对插管的满意度、气道阻塞评分及不良反应（心动过缓、呼吸抑制、躁动、对插管有记忆）的发生率。结果　时间和干预方式对HR、MAP、BIS值及Ramsay镇静评分有交互作用（P＜0.05），对SPO2无交互作用（P＞0.05），只有时间因素影响SPO2（P＜0.05）。组间多重比较显示，D2组在T1、T2时点HR、MAP较C组降低，在T2时点较D1组降低（P＜0.05）；D3组较C组、D1组在T1、T2时点HR、MAP降低；D3组心动过缓发生率较C组升高（P＜0.05）；与C组、D1组比较，D2、D3组在T1、T2时点的BIS值降低、Ramsay镇静评分升高，躁动和对插管有记忆的发生率降低，气管插管耐受度增强，气管插管时间缩短，插管满意度高（P＜0.05）。结论　地佐辛联合DEX可有效安全地用于OSAHS患者的AFNI，且以地佐辛0.1 mg/kg联合DEX 1 µg/kg时，既能维持患者血流动力学稳定又能减少不良反应发生率。

Effects of dezocine combined with different loading dose of dexmedetomidine on awake fiberoptic nasotracheal intubation in patients with obstructive sleep apnea-hypopnea syndrome

Objective　To observe the efficacy of dezocine combined with different loading dose of dexmedetomidine on awake fiberoptic nasotracheal intubation (AFNI) guided by fiberoptic bronchoscopy in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods　Eighty patients with OSAHS were randomly assigned into 4 groups：the dezocine group (group C)，the dezocine 0.1 mg/kg combined with DEX 0.5 μg/kg group (group D1)，the dezocine 0.1 mg/kg combined with DEX 1 μg/kg group (group D2) and the dezocine 0.1 mg/kg combined with DEX 1.5 μg/kg group (group D3), 20 cases in each group．All patients were given 0.1 mg/kg of dezocine intravenously. The same amount of normal saline was intravenously pumped in group C, and DEX was infused over 10 min by micro-injection pump (group D1: 0.5 μg/kg，group D2: 1 μg/kg，group D3: 1.5 μg/kg) before intubation respectively. DEX 0.5, 1 and 1.5 µg/kg were intravenously pumped in group D1, group D2 and group D3, respectively. Naso-pharyngeal and laryngeal mucous membrane were sprayed with 2% lidocaine for topical anesthesia 5 min before intubation in the four groups. AFNI was performed after the end of administration in the four groups. The heart rate (HR)，mean arterial pressure (MAP)，oxygen saturation (SPO2)，the value of BIS and Ramsay sedation score at entering the OR (T0)，the end of administration (T1) and after intubation (T2) were observed between the four groups. Intubation tolerance, intubation time, patient satisfaction, airway obstruction score and incidence of adverse reactions (bradycardia, respiratory depression, agitation, memory of intubation) were also compared between the four groups. Results　Repeated-measures ANOVA showed that there were interaction between time factor and different intervenient measures on HR, MAP, BIS value and Ramsay sedation score during the experiment (P＜0.05), while there was no interaction with SPO2 (P＞0.05), only time factor affected SPO2 (P＜0.05). Further comparison between the four groups showed that HR and MAP were lower at T1 and T2 in the group D2 than those of the group C (P＜0.05), while HR and MAP were lower at T2 in the group D2 than those in the group D1 (P＜0.05). Compared with the group C and the group D1, the HR and MAP were lower at T1 and T2 in the group D3 (P＜0.05). HR and MAP were lower at T1 and T2 in the D3 group than those in the C group and the D1 group. The incidence of bradycardia was higher in the group D3 than that in the group C (P＜0.05). Compared with the group C and the group D1, the BIS values were lower at T1 and T2, and the Ramsay sedation scores were increased in the group D2 and the group D3 (P＜0.05). The incidence of dysphoria and the remembering of the AFNI, the intubation time were decreased, but the tolerance of AFNI and the patients’ satisfaction with the AFNI were increased in the group D2 and the group D3 than those in the group C and the group D1 (P＜0.05). Conclusion　Dezocine combined with DEX can effectively and safely used for AFNI in patients with OSAHS. In addition, dezocine 0.1 mg/kg combined with DEX 1 μg/kg can not only maintain hemodynamic stability of patients but also reduce the incidence of adverse reactions.