李永宏，丁　辉(陕西省第二人民医院麻醉科，陕西 西安　710005)



右美托咪定与芬太尼类药物在清醒气管插管患者麻醉诱导中的效果比较

李永宏*，丁辉(陕西省第二人民医院麻醉科，陕西 西安710005)

DOI10.14009/j.issn.1672-2124.2016.03.026

摘要目的：比较右美托咪定与芬太尼类药物对清醒气管插管患者的麻醉诱导效果。方法：以陕西省第二人民医院2013年2月—2014年12月120例择期经鼻清醒气管插管麻醉患者为研究对象，按随机数字表法分为A、B组各60例，A组患者行右美托咪定麻醉，B组行芬太尼麻醉，比较2组患者不同时间点心率、血压、血氧饱和度变化情况，同时记录患者插管反应及插管知晓情况。结果：A组患者插管成功即刻的心率为(73.0±15.2)次/min，收缩压为(121.0±11.6)mmHg(1 mmHg=0.133 kPa)；B组为(85.6±9.2)次/min、(131.6±8.0)mmHg，2组的差异有统计学意义(P<0.05)。A组患者出现恶心2例(3.3%)、呛咳3例(5.0%)；B组恶心12例(20.0%)、呛咳15例(25.0%)、躁动9例(15.0%)，2组的差异有统计学意义(P<0.05)。A组患者插管知晓率为3.3%，B组为25.0%比较，2组的差异有统计学意义(P<0.05)。结论：右美托咪定在患者清醒气管插管麻醉中具有血流动力学稳定、插管反应少、插管知晓率低等特点，值得临床推广。

关键词右美托咪定； 芬太尼； 清醒气管插管； 麻醉诱导

Comparison of Anesthesia Induction Effect of Dexmedetomidine and Fentanyl Drugs on Sobering Patients with Tracheal Intubation

LI Yonghong, DING Hui (Dept. of Anesthesiology, the Second People’s Hospital of Shanxi, Shanxi Xi’an 710005, China)

ABSTRACTOBJECTIVE：To compare the anesthesia induction effect of dexmedetomidine and fentanyl drugs on sobering patients with tracheal intubation. METHODS: 120 patients undergoing transnasal conscious endotracheal intubation anesthesia admitted into the Second People’s Hospital of Shanxi from Feb. 2013 to Dec. 2014 were selected to be divided into group A and group B via the random number table, with 60 cases in each. Group A received dexmedetomidine anesthesia while group B were given fentanyl anesthesia. Changes of heart rate, blood pressure and oxygen saturation were compared between two group of patients at different time points, the intubation reactions and intubation awareness rate were recorded. RESULTS: The heart rate after immediate induction of anesthesia in group A was(73.0±15.2)times/min, systolic blood pressure was (121.0±11.6) mmHg (1 mmHg=0.133 kPa), and in group B were respectively (85.6±9.2) times/min and (131.6±8.0) mmHg, with statistically significant difference(P<0.05). In group A, there were 2 case(3.3%) of nausea, 3 cases (5.0%) of bucking, while in group B were respectively 12 cases(20.0%) of of nausea, 15 cases (25.0%) of bucking, 9 cases(15.0%) of restlessness, with statistically significant difference(P<0.05). The awareness rate of intubation in group A was 3.3%, compared with group B 25.0%, the difference was statistically significant(P<0.05). CONCLUSIONS: Dexmedetomidine has such characteristics as stable hemodynamics, fewer intubation reactions and low intubation awareness rate in sobering patients with tracheal intubation. It is worthy of clinical application and promotion.

KEYWORDSDexmedetomidine; Fentanyl; Sobering tracheal intubation; Anesthesia induction

患者清醒时气管插管会兴奋交感神经，造成患者心率加快、血压上升，严重时导致患者心跳骤停，危险系数大[1]。右美托咪定属于α2受体激动剂，具有高选择性、特异性特点，镇痛、镇静效果良好，且能有效抑制交感神经兴奋，适用于气管插管中麻醉[2]；但该药物可能引发低血压、心动过缓现象[3]。本研究对右美托咪定与芬太尼对清醒气管插管患者的麻醉诱导效果进行比较，现报告如下。

1资料与方法

1.1资料来源

选择陕西省第二人民医院2013年2月—2014年12月择期行经鼻清醒气管插管麻醉患者120例作为研究对象。纳入标准： 美国麻醉师协会分级I或II级；符合气管插管指征。排除标准：肝、肾功能严重障碍；……