右美托咪定同时靶控输注丙泊酚用于慢诱导纤维支气管镜
引导经鼻气管内插管术的临床观察
宋丽;袁维秀;米卫东
【期刊名称】《国际麻醉学与复苏杂志》 【年(卷),期】2016(037)009
【摘要】Objective To study the safety and feasibility of dexmedetomidine(Dex) combined with propofol target-controlled infusion (TCI) for sedation during fiberoptic bronchoscopy (FOB)-assisted nasotracheal intubation.Methods One hundred and forty-three ASA grade Ⅰ,H patients underwent general anesthesia for oral cancer surgery,aged 18-65 years with body mass index of 18-30 kg/m2,were randomly assigned into propofol TCI group (group P,n=65) or Dex group (group D,n=78).All Patients received fentanyl 1.5 μg/kg after entering the operating room,followed by propofol TCI with the initial target plasma concentration (Cp) 1.0 mg/L which was adjusted according to BIS,group D received Dex (0.5 μg/kg,10 min) at the same time.2% tetracaine 2.5 ml was injected into tracheal through cricothyroid membrane and naso-pharyngeal membrane was infiltrated with 1% tetracaine 2 ml for topical anesthesia in both groups until BIS value fell to 85.When the BIS value was between 80 and 70,FOB was loaded,once it passed the glottis,then the tracheal tube was placed,patients in both groups were administrated propofol 1 mg/kg in
the meantime.General anesthesia was commenced after the
nasotracheal tube was secured.The intraoperative and postoperative events including HR,MAP,SpO2 and BIS were recorded at five time points:patients arrived at the operating room (To),BIS value fell to 85 (T1),after the cricothyroid membrane puncture (T2),BIS value was between 80-70 (T3),after the FOB placement (T4) and after the tracheal intubation (T5).Meanwhile propofol effect-site concentrations (Ce) at the time of T1 and T3 were recorded respectively.Results There were no significant differences between the two groups in the difficulty of intubation,tracheal intubation time,incidence of cough or aspiration (P>0.05).Compared with group P,airway obstruction score was significantly increased (48/7/20/3/0 vs 45/16/4/0/0),patients were more comfortable (62/16/0/0/0 vs 35/29/0/1/0),pain recall score was significantly increased (60/18/0 vs 62/3/0),postoperative sore throat score was significantly
increased
(22/55/1/0
vs
41/20/4/0)
in
group
D.However,hemodynamic changes were better in group D (P<0.05).On the other hand,we found no significant differences in the propofol Ce mean at T1 (P>0.05),but the propofol Ce mean at T3 were significantly decreased [(1.00±0.20) mg/L vs (1.10±0.30) mg/L] in group D compared with group P (P<0.05).Conclusions The infusion of Dex (0.5 μg/kg,10 min) used to supplement the topical anesthesia for FOB-assisted nasotracheal intubation decreased the propofol Ce for sedation and
made patients more comfortable,but the complications such as airway obstruction,recall of the procedure and sore throat need to be considered.%目的 观察右美托咪定(dexmedetomidine,Dex)同时靶控输注(target controlled infusion,TCI)丙泊酚用于慢诱导纤维支气管镜(fiberoptic bronchoscopy,FOB)引导经鼻气管内插管术的可行性和安全性. 方法 拟行全身麻醉下颌面部肿瘤切除术的患者143例,年龄18~65岁,BMI 18~30 kg/m2,ASA分级Ⅰ、Ⅱ级,完全随机分为丙泊酚TCI组(P组,65例)和Dex组(D组,78例).入室后两组均静脉注射芬太尼1.5 μg/kg,TCI丙泊酚,丙泊酚初始血浆靶浓度(plasma concentration,Cp)为1.0 mg/L.D组同时负荷输注Dex(0.5μg/kg,10 min).根据BIS调整丙泊酚Cp.BIS值降至85时环甲膜穿刺注射2%丁卡因2.5 ml,1%丁卡因2ml行鼻腔黏膜表面麻醉.BIS值降至80~70时放置FOB.FOB进入声门后,两组均静脉注射丙泊酚1 mg/kg,放置气管导管并确定其位置,完成麻醉诱导.记录插管术中及术后情况,记录入室安静后(To)、BIS值降至85时(T1)、环甲膜穿刺后即刻(T2)、BIS值降至80~70时(T3)、FOB放置成功时(T4)和气管内插管成功时(T5)的HR、MAP、Sp02和BIS,记录T1和T3时丙泊酚效应室浓度(effect-site concentration,Ce). 结果 两组气管内插管难易度评分、气管内插管时间、呛咳或误吸率差异均无统计学意义(P>0.05);与P组比较,D组气道阻塞评分升高(48/7/20/3/0比45/16/4/0/0)、舒适度升高(62/16/0/0/0比35/29/0/1/0)、插管记忆评分升高(60/18/0比62/3/0)、术后咽痛评分升高(22/55/1/0比41/20/4/0),D组血流动力学更稳定,差异有统计学意义(P<0.05).两组患者T1时丙泊酚Ce差异无统计学意义(P>0.05);与P组比较,D组T3时丙泊酚Ce降低[(1.00±0.20) mg/L比
右美托咪定同时靶控输注丙泊酚用于慢诱导纤维支气管镜引导经鼻气
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