右美托咪定与咪达唑仑复合舒芬太尼在可视喉镜清醒气管插管患者中的应用

[目的]探讨右美托咪定与咪达唑仑复合舒芬太尼用于困难气道患者可视喉镜清醒气管插管中的有效性和安全性.[方法]选择2015年9月至2015年12月长沙市第一医院收治的临床评估为困难气道患者40例,所有患者均为Mallampati分级＞Ⅲ级.将其随机分为两组,右美托咪定和咪达唑仑复合舒芬太尼组(DM组)与咪达唑仑复合舒芬太尼组(M组),每组各20例.气管插管前15 min,DM组予右美托咪定1μg/kg、咪达唑仑0.01 mg/kg静脉泵注,M组予咪达唑仑0.02mg/kg静脉泵注,DM组和M组插管前5 min均予舒芬太尼0.1 μg/kg,生理盐水稀释至1μg/mL,静脉滴注,输注结束后两组均行环甲膜穿刺注2％利多卡因3 mL,所有患者均选择可视喉镜行经口气管内插管.记录两组入室后10 min(T0)、环甲膜穿刺前(T1)、环甲膜穿刺后(T2)、可视喉镜置入口腔时(T3)、气管导管插入声门时(T4)的心率(HR)、收缩压(SBP)和舒张压(DBP)值,记录两组患者在T0、T1、T2时的Ramsay镇静评分,记录插管过程中的嗜睡、呼吸抑制、缺氧、呛咳情况,术后声嘶、咽痛发生率.[结果]DM组T4时HR、SBP、DBP均显著低于M组,差异具有统计学差异(均P＜0.05);与T0时HR、SBP、DBP比较,DM组、M组T1时HR、SBP、DBP显著低于T0时,差异具有统计学意义(P＜0.05);M组T4时HR、SBP、DBP均显著高于T0时,差异均具有统计学意义(均P ＜0.05).M组患者T1、T2时的镇静评分显著高于DM组,差异具有统计学意义(P＜0.05);与T0比较,DM组、M组患者T1、T2时的镇静评分显著升高,差异具有统计学意义(均P ＜0.05).M组嗜睡、呛咳发生率显著高于DM组,差异均具有统计学意义(均P＜0.05);两组呼吸抑制、咽痛发生率比较,差异均无统计学意义(均P＞0.05),两组患者均未出现声嘶.[结论]右美托咪定与咪达唑仑复合舒芬太尼用于困难气道患者可视喉镜下清醒气管插管,较咪达唑仑复合舒芬太尼更具优势,其血压和心率更平稳,且嗜睡、呼吸抑制、呛咳等不良反应的发生率更低.

Application of Dexmedetomidine and Midazolam Combined with Sufentanil in Patients with Visible laryngoscopy Conscious Tracheal Intubation

[Objective]To investigate the efficacy and safety of dextromethorphan and midazolam combined with sufentanil in patients with difficult airway using visible laryngoscopy (glidescope) conscious tracheal intubation.[Methods]Forty patients with difficult airway (Mallampati grade ＞ Ⅲ) from the First Hospital of Changsha were randomly divided into two groups:the dexmedetomidine and midazolam combined with sufentanil (group DM),and the midazolam combined with sufentanil group (group M),with 20 cases in each group.At 15min before tracheal intubation,group DM was treated with dexmedetomidine (1μg/kg) and midazolam intravenous infusion (0.01 mg/kg),while group M received intravenous infusion of midazolam 0.02mg/kg.At 5min before intubation group DM and group M were given sufentanil (0.1μg/kg,dilute with saline at 1ug/ml,intravenous drip).After the infusion,patients of two groups underwent thyrocricoid puncture injection of 2％ lidocaine (3ml).All patients were selected to be intubation through mouth by gliscope (visible laryngoscopy).Heart rate (HR),systolic blood pressure (SBP),and diastolic blood pressure (DBP) were recorded at entering OR 10min (T0),before thyrocricocentesis (T1),post-thyrocricocentesis (T2),video laryngoscope (T3),and tracheal catheter insert the glottis (T4).Ramsay sedation score of the two groups of patients at T0,T1 and T2 were recorded as well.Lethargy,respiratory depression,hypoxia and cough (choking) in the process of intubation were recorded as well as postoperative hoarseness and incidence of sore throat.[Results]At T4,the HR,SBP and DBP in group DM were significantly lower than those in group M (P ＜0.05).In both group DM and group M,the values of HR,SBP and DBP at T1 were significantly lower than those at T0 (P ＜0.05).The values of HR,SBP and DBP at T4 in group M was significantly higher than those at T0.There was no significant difference in sedation score between the two groups in the T0.The sedation scores at T1 and T2 in group M were higher than those in group DM (P ＜0.05).In both group DM and group M,the sedation scores at T1 and T2 were significantly higher than those at T0 (P ＜0.05).The incidence of drowsiness (lethargy) and cough (choking) of group M were significantly higher than those of group DM (P ＜0.05).There was no significant difference in the incidence of respiratory depression and sore throat between the two groups (P ＞ 0.05).There was no hoarseness in both groups.[Conclusion]Compared to midazolam combined with sufentanil,dexmedetomidine and midazolam combined with sufentanil for patients with difficult airway undergoing visible laryngoscopy (glidescope) conscious tracheal intubation has more advantages.It can keep blood pressure and heart rate more stable and lowering incidence rate of drowsiness,cough (choking),and other adverse reactions.