右美托咪啶镇静在困难气道清醒纤维支气管镜插管中的应用

目的:观察右美托咪啶应用于困难气道清醒纤维支气管镜插管的效果和安全性.方法:将预计为困难气道需全麻手术的患者28例随机分为两组,在表面麻醉基础上,右美托咪啶组(Dex组,n=15例)泵注右美托咪啶(负荷剂量1 μg/kg,10 min泵完,0.5 μg· kg-1· h-1维持)；空白对照组(Control组,n=13例)泵注生理盐水,泵注方法同Dex组.术中监测并记录基础值、置入纤支镜前1 min及此后每分钟的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),行RSS评分、纤支镜置入评分、插管评分.结果:Dex组RSS评分较Control组高(P＜0.05),纤支镜置入评分、插管评分等均优于Control组(P＜0.05),插管期间血流动力学变化较Control组小(P＜0.05),两组患者SpO2均无明显变化.结论:右美托咪啶用于清醒纤维支气管镜插管可提供满意的插管条件,无呼吸抑制,安全可行.

Application of Dexmedetomidine for Awake Fiberoptic Intubation with Difficult Airway

Objective： To observe the effect and safety on awake fiberoptic intubation （AFOI） with dexmedetomidine. Methods： 28 cases scheduled for general anesthetic with predicted difficult airways were assigned randomly to two groups. After superficial anesthetic, Group Dex received dexmedetomidine as a loading dose of 1 μg/kg for 10 min followed by a maintenance infusion of 0.5μg·kg^-1·h^-1, when Group control received normal saline placebo infusion. Mean arterial blood pressure （MAP）, heart rate （HR）, pulse oxygen saturation （SpO2） were continually monitored during AFOI. RSS score, FOB score, endotracheal intubation score were recorded as well. Result： Group Dex got a higher RSS score than Group control （P〈0.05）. The FOB score, endotracheal intubation score were better in Group Dex than Group control （P〈0.05）. The hemodynamics of Group Dex was more stable than Group control during AFOI （P〈0.05）. No SpO2 changes were observed during the procedure. Conclusion： Dexmedetomidine may be effective and safe in providing a satisfaction condition for AFOI with no respiration inhibition.