右美托咪定复合七氟烷用于困难气道插管30例临床评价

目的：评价右美托咪定复合七氟烷在困难气道插管中的安全性及有效性。方法选择美国麻醉医师协会（ASA）分级Ⅰ~Ⅱ级、年龄20~60岁的困难气道患者60例，随机均分为右美托咪定组（D组）和空白对照组（C组）。D组插管前15 min静脉输入右美托咪定0.5μg/kg，10 min后以0.5μg/（ kg＆#183;h ）的速率泵注；C组以同样的方式静脉输注0.9%氯化钠溶液。两组患者均以七氟烷行诱导插管。记录两组患者麻醉前（T0）、插管前即刻（T1）、窥视会厌（T2）、插管成功即刻（T3）、插管后1 min（T4）、插管后3 min（T5）时心率（HR）、平均动脉压（MAP）变化，并观察患者呛咳、恶心及躁动等不良反应，脉搏血氧饱和度（SpO2）下降及插管知晓的发生率。结果两组T0时点的HR，MAP无明显差异（ P＞0.05）；与T0比较，D组T1~T5时HR降低（ P〈0.05），但组间比较无显著差异（ P＞0.05）；C组T2~T3时HR显著增加（ P〈0.05），明显高于D组（ P〈0.05）；与T0比较，C组T2~T3时MAP增高（ P〈0.05），且高于D组（ P〈0.05），而D组各时点MAP无明显变化（ P＞0.05）；D组患者插管反应、插管知晓及SpO2下降发生率均明显低于C组（ P〈0.05）。结论与单纯应用七氟烷诱导困难气道插管相比，右美托咪定复合七氟烷可提供更稳定的血流动力学且不良反应发生率低。

Clinical Evaluation of Dexmedetomidine Combined with Sevoflurane in 30 Cases of Difficult Tracheal Intubation

Objective To evaluate the safety and effectiveness of dexmedetomidine combined with sevoflurane in difficult tracheal intuba-tion. Methods 60 patients aged 20-60 years old, ASA Ⅰ-Ⅱ, with difficult airway were randomly and equally divided into the dexmedetomidine group （ D ） and the blank control group （ C ） . The group D was intravenously infused with dexmedetomidine 0. 5μg/kg at 15 min before tracheal intubation, then 10 min later, change to maintain the pump infusion with 0. 5 μg/ （kg＆#183;h）;the group C was intravenously infused with the equal amount of normal saline. These two groups were performed the tracheal intubation by the sevoflu-rane induction. The heart rate （ HR ） and mean arterial pressure （ MAP ） were recorded before anesthesia （ T0 ） , immediately before intu-bation （ T1 ） , peeping epiglottis （ T2 ） , intubation success （ T3 ） , 1 min after intubation （ T4 ） and 3 min after intubation （ T5 ） . The adverse reactions of bucking, nausea and agitation during tracheal intubation were observed and the occurrences of pulse oxygen saturation （ SpO2 ） decrease and awareness of the intubation were recorded. Results HR and MAP at T0 had no statistically significant differences between the two groups （ P〉0. 05 ）;HR at T1-T5 in the group D was decreased compared with that at T0 （ P〈0. 05 ） , but there was no statistically significant differences between the two groups （ P〉0. 05 ）; HR at T2-T3 in the group C was markedly increased com-pared with that at the same points in the group D （ P〈0. 05 ）;compared with T0, MAP at T2-T3 in the group C was increased, which was higher than that in the group D （ P〈0. 05 ） , but MAP at various time points in the group D had no significant change （ P〉0. 05 ）;the occurrence rates of intubation reaction, intubation awareness and SpO2 decrease in the group D were significantly lower than those in the group C （ P〈 0. 05 ） . Conclusion Compared with simple sevoflurane used in the red