右旋美托咪啶和瑞芬太尼应用于纤维支气管镜清醒气管插管的比较

目的 比较右旋美托咪啶与瑞芬太尼用于纤维支气管镜（FOB）引导经鼻清醒气管插管对患者呼吸、循环及满意度的影响.方法 择期拟行纤维支气管镜引导经鼻清醒气管插管的手术患者38例,随机分为2组（n=19）：组Ⅰ（右旋美托咪啶组）和组Ⅱ（瑞芬太尼组）.2组患者均先静脉辅助咪达唑仑0.05～0.1 mg·kg-1,然后按照分组不同分别给予右旋美托咪啶或瑞芬太尼.组Ⅰ：右旋美托咪啶先给负荷量0.2 μg·kg-1,然后以0.4～2 μg·kg-1·h-1持续输注,调整输注速度维持MOAA/S评分大于或等于2分.组Ⅱ：瑞芬太尼先给负荷量0.5 μg·kg-1,然后以1～5 μg·kg-1·h-1持续输注,调整输注速度维持同样的镇静深度.记录患者在此期间氧饱和度、血流动力学、患者满意度及操作时间.结果 组Ⅰ患者发生低氧的发生率明显比组Ⅱ低（5.26% vs 42.11%,P〈0.01）,低血压、心动过缓、心动过速、高血压及心律失常等并发症的发生率2组间无明显区别（P〉0.05）.组Ⅱ患者在纤维支气管镜进入时心率增加明显,并且氧饱和度降低尤为明显（P〈0.05）.术后组Ⅰ患者对插管过程的满意度明显低于组Ⅱ（P〈0.05）.结论 清醒纤维支气管镜插管期间右旋美托咪啶镇静比瑞芬太尼对患者的呼吸和循环影响更小,但不能改善患者的满意度.

A comparative study of dexmedetomidine and remifentanyl for sedation during awake fiberoptic intubation

Objective To evaluate the efficacy and safety of dexmedetomidine versus refentanyl for sedation during awake fiberoptic intubation （AFOI）. Methods 38 ASA physical status I -III patients scheduled for non - emergency surgery with AFOI were randomly divided into two groups （n = 19 each）： Group Ⅰ： sedation with demedetomidine; Group Ⅱ： sedation with refentanyl. All patients received intravenous （ IV ） midazolam 0.05 mg·kg^-1 followed by dexmedetomidine or remifentanyl according to different group. Sedation was achieved initially with a bolus dose of dexme- detomidine 0.2 μg · kg^-1 or remifentanyl 0.5 p,g ~ kg - 1 , followed by 0.4 - 2 μg · kg^-1. h - t dexmedetomidine （ group I ） or 1 - 5 μg · kg^-1 . h^-1 remifentanyl （ group ]] ） continuous infusion at the discretion of the anesthesiologist. The infusion rate was adjusted according to the sedation score modified observer＇s assessment of alertness/sedation （ MOAA/ S） ]. The oxygen saturation, hemodynamic variables, side effects, satisfaction scores of patients, and operation time were recorded. Results The incidence of oxygen desaturation was significantly lower in group I than in group Ⅱ （5. 26% vs. 42.11% , P = 0. 008 ）. There were no obvious differences in other complications including hypotension, brady- cardia, tachycardia, hypertension and arrhythmia between the two groups （P 〉 0.05 ）. The heart rate increased significantly and in particular oxygen saturation decreased significantly in group Ⅱ compared to group I （ P 〈 0.05 ） during the insertion of fiberoptic bronchoscope. However, patients＇ satisfaction scores were significanly lower in group Ⅰ compared to group Ⅱ （P 〈 0.05）. Conclusions Dexmedetomidine has lower incidence of oxygen desaturation than remifentanyl for sedation during AFOI, but with a poorer patients＇ satisfaction score.