右美托咪定联合表面麻醉用于面部骨折手术经鼻清醒气管插管的临床观察

目的观察右美托咪定联合表面麻醉用于面部骨折手术经鼻清醒气管插管的安全性及可行性。方法选择择期行面部骨折手术患者(ASAⅠ~Ⅱ级)40例,采用随机数字表法随机分为2组,每组20例。入室后两组均行鼻内、口腔内表面麻醉及环甲膜穿刺。A组给予右美托咪定诱导量0.5μg/kg缓慢泵注10 min后行经鼻清醒气管插管。B组以同样方法泵注等剂量0.9%生理盐水后行经鼻清醒气管插管。观察并记录两组患者入室(基础值,T_0)、插管前(T_1)、气管导管过鼻腔即刻(T_2)、气管导管进入声门即刻(T_3)、插管后2 min(T_4)的平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_2)。记录插管过程中T_2、T_3时点躁动、恶心、呛咳等不良反应的发生例数。结果两组患者一般情况及各时点SpO_2比较差异无统计学意义(P>0.05);与T_0时比较,T_1时A组MAP、HR明显降低(P<0.05);T_2~T_4时,B组MAP明显升高,HR明显增快(P<0.05)。与A组相比,B组在T_1~T_4时患者的MAP、HR均明显增高,差异均有统计学意义(P<0.05)。结论右美托咪定联合表面麻醉可安全有效地用于面部骨折手术经鼻清醒气管插管,减少血流动力学波动,降低不良反应的发生率。

Dexmedetomidine combined with surface anesthesia for facial fractures:clinical ob-servation of awake nasal intubation

Objective To observe the safety and feasibility of awake nasal intubation in dexmedetomidine combined with surface anesthesia for facial fractures. Methods Forty patients ( ASAⅠ ~Ⅱ) were divided into two groups (group A and group B),20 cases in each group. After entering the operation room,the two groups underwent nasal and oral cavity surface anesthesia and thyrocricoid puncture. Group A received dexmedetomidine induced amount of 0. 5 g/kg by slow infusion for 10 min and then awake nasal intubation was performed. Group B received the same method of pump injection of 0. 9% physiological saline through the awake nasal intubation. The mean arterial pressure ( MAP) ,heart rate ( HR) and blood oxygen saturation ( SpO2 ) of the patients in the two groups at the time of entering the operation room ( the foundation value,T0 ) ,before intubation ( T1 ) ,at the time of nasal intubation ( T2 ) ,at the time of tracheal catheter into the glottis ( T3 ) and 2 min after intubation ( T4 ) were observed and recorded. The number of adverse reactions,such as agitation, nausea, cough and other adverse reactions at T2 and T3 was recorded. Results There was no statistical difference (P>0. 05) between the two groups of patients concerning the general situation and SpO2. Compared with T0,MAP and HR in group A at T1 decreased significantly (P<0. 05);during T2 ~T4,MAP and HR in group B increased significantly (P<0. 05). Compared with group A,MAP and HR in group B during T1 ~T4 increased significantly (P<0. 05). Conclusion Dexmedetomidine combined with surface anesthesia can be safely and effectively used in facial fractures for awake nasal intubation,and it can reduce the fluctuation of hemodynamics and the incidence of adverse reactions.