右美托咪定在困难气道患者纤维支气管镜插管中的麻醉效果

目的 探讨右美托咪定在困难气道患者纤维支气管镜（纤支镜）插管中的麻醉效果.方法 选择我院2010年1月-2013年3月行纤支镜插管的63例为研究对象,随机分为观察组35例,对照组28例.对照组采用表面麻醉＋瑞芬太尼麻醉方法,观察组在此基础上加用右美托咪定麻醉.记录两组入手术室时（T0）、给药后（T1）、插管前（T2）、插管时（T3）、插管后（T4）、插管完成后5 min（T5）的平均动脉压（MAP）、脉搏氧饱和度（SaO2）、心率（HR）,并对镇静效果进行Ramsay评分.结果 两组MAP在T1、T2、T3时组间比较及与组内T0比较差异均有统计学意义（P＜0.05）;HR在T1、T2、T3时观察组与对照组比较差异亦有统计学意义（P＜0.05）.对患者进行Ramsay镇静评分,观察组在T2、T3、T4、T5时与对照组比较差异有统计学意义（P＜0.05）,且对患者的呼吸抑制作用不明显.结论 困难气道患者麻醉时应用右美托咪定与瑞芬太尼可抑制清醒患者的血管应激反应,对其呼吸抑制作用亦较轻,安全可行且效果肯定.

Anesthesia Effect of Dexmedetomidine on Difficult Airway Patients with Intubation under Bronchofibroscope

Objective To explore the anesthetic effect of Dexmedetomidine on difficult airway patients with intubation under bronchofibroscope.Methods A total of 63 patients with the fiberoptic intubation during January 2010 and March 2013 in our hospital were randomly divided into observation group （n =35） and control group （n =28）.Topical anesthesia and Remifentanil anesthesia were used in control group,while Dexmedetomidine anesthesia was given in observation group based on the method of control group.The mean arterial pressure （MAP）,pulse oxygen saturation （SaO2） and heart rate （HR） in the two groups were recorded on entering the operating room （T0）,after administration （T1）,before intubation （T2）,during intubation （T3）,after intubation （T4） and 5 min after intubation （T5）,and the sedation effect was assessed with Ramsay score.Results The differences of MAP on T1,T2 and T3 in group comparison and compared with that on T0 in the same group were statistically significant （P ＜ 0.05） ; the differences of HR on T1,T2 and T3 in the two groups were statistically significant （P ＜0.05）.Scores of Ramsay sedation on T2,T3,T4 and T5 had significant differences in the two groups （P ＜0.05）,and there was no significant inhibitory effect on the patient＇s breathing.Conclusion Anesthesia with Dexmedetomidine and Remifentanil for patients with difficult airway may inhibit vascular stress reaction in conscious patients with slight respiratory depression,and it is safe,feasible and effective.