摘要
目的观察右美托咪定复合舒芬太尼对颈椎损伤患者纤维支气管镜引导经鼻清醒气管插管中应激反应的影响。方法选择美国麻醉医师协会（ASA）Ⅰ级或Ⅱ级颈椎损伤手术患者40例，随机分为舒芬太尼组（Ⅰ组，n=20）和右美托咪定复合舒芬太尼组（Ⅱ组，n=20）。所有患者均行环甲膜穿刺注射2％利多卡因3ml。Ⅰ组静脉注射舒芬太尼0．1μg/kg；Ⅱ组先静脉输注右美托咪定负荷量0．6μg/kg（10rain），再以每小时0．3μg/kg维持，负荷量注射结束时静脉注射舒芬太尼0．1μg／kg，3min后于纤维支气管镜引导下行经鼻清醒气管插管术。记录环甲膜穿刺开始至气管插管后3min内心血管反应和呼吸抑制的发生情况，记录气管插管时间，评价气管插管条件和患者对气管插管的耐受性；用酶联免疫吸附试验（ELISA）法检测环甲膜穿刺前（T0）、气管插管前（T1）、气管插管后1、3min（T2，T3）时血浆肾上腺素（E）和去甲肾上腺素（NE）水平。结果与Ⅰ组比较，Ⅱ组心血管反应发生率降低，气管插管时间缩短[（59．61±10．30）s比（80．34±11．20）s]；声带活动评分、咳嗽评分和体动反应评分增加（3．1±0．5比1．8±0．3、3．1±0．4比2．1±0．3、3．2±0．6比2．1±0．4）；气管插管时耐受性评分和气管插管后耐受性评分增高（3．3±0．5比2．3±0．4、2．5±0．3比1．6±0．3，P〈0．05），两组呼吸抑制发生率差异无统计学意义（P〉0．05）；Ⅰ、Ⅱ组T1时血浆E和NE水平[（17．36±3．00）ng／L和（289．74±34．20）ng／L、（14．65±3．40）ng／L和（261．74±45．30）ng／L]较哟时降低[（21．74±2．30）ng/L和（311．74±30．10）ng／L、（22．25±2．40）ng/L和（315．83±31．30）ng／L，P〈0．05]。Ⅱ组T1、T2、113时血浆E和NE水平[（14．65±3．40）ng／L和（261．74±45．30）ng/L、（24．35±2．60）ng／L和（338．57±43．20）ng／L、（23．31±3．10）ng/L和（323．57±45．60）ng／L]较Ⅰ组[（17．36±3．00）ng／L和（289．74±34．20）ng／L、（32．37±2．80）ng／L和（436．68±47．30）ng／L、（30．25±2．70）ng／L和（412．37±40．90）ng／L]降低（P〈0．05）。结论与单独应用舒芬太尼比较，右美托咪定复合舒芬太尼用于颈椎损伤患者纤维支气管镜引导经鼻清醒气管插管时能提供更好的插管条件，且血流动力学平稳，应激反应减轻。
Objective To evaluate the Effects of dexmedetomidine combined with sufentanil on stress response for awake nasotracheal intubation assisted by fiberoptic bronchoscope （FOB） in patients with cervical injury. Methods Forty ASA Ⅰ or Ⅱ patients with cervical fracture were randomly divided into snfentanil group （ group Ⅰ , n = 20） and dexmedetomidine combined with sufentanil group （ group Ⅱ , n =20） . 2% lidocaine 3 ml was injected into trachea through cricothyroid membrane in all patients. Sufentanil 0. 1 μg/kg was infused over 1 rain at 3 min before awake nasotracheal intubation assisted by FOB in group Ⅰ , In group Ⅱ a loading dose of 0. 6 μg/kg dexmedetomidine was infused over 10 minutes before 0. 1 ug/kg sufentanil infusion, and followed by a maintenance dose 0. 3 μg/（kg.h） dexmedetomidine. Awake nasotracheal intubation assisted by FOB was performed at 3 min after the end of administration of 0. 1 μg/kg sufentanil. Cardiovascular response and respiratory depression were recorded during the period between the injection through cricothyroid membrane and 3 min after intubation was completed. The intubation time was also recorded. The intubation condition and the tolerance of tracheal tube were assessed. Before the injection through cricothyroid membrane （T0） , before intubation （T1） , and at 1 and 3 min after intubation （ T2 and T3 ） , blood samples were taken to determine the plasma levels of epinephrine （E） and norepinephrine （NE） . Results Compared with group Ⅰ , the incidence of cardiovascular response was significantly decreased, intubation time was shortened （59. 61 ±10. 30） s vs. 80. 34± 11.20） s, the intubation condition and the tolerance of tracheal tube were significantly enhanced in group Ⅱ （P 〈 0. 05 ） , there was no significant difference in respiratory depression between two groups （P 〉 0. 05）. The plasma levels of E and NE were significantly decreased at T1 in two groups [ （17. 36 ± 3.00） ng/L and （289. 74 ± 34. 20） ng/L, （14. 65 ±3.40） ng/L and （261.74 ±45. 30） ng/L] than that at TO [（21.74±2.30） ng/L and （311.74 ±30.10） ng/L, （22.25 ±2.40） ng/L and （315.83 ± 31.30） ng/L （ P 〈 0. 05 ]. The plasma levels of E and NE in group Ⅱ at T1, T2, T3 [ （ 14. 65 ± 3.40） ng/L and （261.74±45.30） ng/L, （24.35 ±2.60） ng/L and （338.57 ±43.20） ng/L, （23.31 ±3. 10） ng/L and （323.57 ±45.60） ng/L] were significantly decreased than that in group Ⅰ [ （ 17.36 ±3.00） ng/L and （289.74±34.20） ng/L, （32.37 ±2.80） ng/L and （436.68±47.30） ng/L, （30.25 ±2.70） ng/L and （412. 37 ±40. 90） ng/L （P 〈 0. 05 ] . Conclusion Dexmedetomidine combined with sufentanil provides better intubation condition, maintains hemodynamies stable and inhibits the stress responses than sufentanil alone when used to supplement awake nasotracheal intubation assisted by FOB in patients with cervical injury.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2016年第2期534-537,共4页
Chinese Journal of Experimental Surgery
基金
郑州大学第一附属医院院内青年基金
