不同剂量右美托咪定滴鼻在麻醉诱导前的应用比较

Comparison of Different Doses of Intranasal Dexmedetomidine Application Before General Anesthesia Induction

关键词:  右美托咪定  滴鼻  麻醉诱导  气管插管  血流动力学

Key words:  dexmedetomidine  intranasal  anesthesia induction  tracheal intubation  hemodynamics

摘要:

目的 探讨右美托咪定(dexmedetomidine，DEX)滴鼻在麻醉诱导前应用的最佳剂量。方法 择期手术的120例患者随机分为对照组和DEX 0.5，1.5，2.5 μg·kg^-1组，术前30 min分别滴鼻生理盐水和相应剂量DEX。观察DEX滴鼻后30 min镇静评分、插管后血流动力学变化(平均动脉压和心率)和不良事件发生例数、拔管时间、拔管后镇痛评分、拔管后发生躁动情况。结果 DEX各剂量滴鼻后患者30 min OAA/S评分均下降(P<0.05)；DEX 1.5 μg·kg^-1组滴鼻后30 min HR和MAP下降(P<0.05)；插管即刻，对照组、DEX 0.5 μg·kg^-1组HR和MAP上升，DEX 2.5 μg·kg^-1组HR和MAP下降(P<0.05)；DEX 1.5 μg·kg^-1组及DEX 2.5 μg·kg^-1组心动过速、高血压发生例数减少(P<0.05)；DEX 2.5 μg·kg^-1组心动过缓、低血压发生例数增多(P<0.05)，拔管时间延长(P<0.05)；DEX 1.5和2.5 μg·kg^-1组拔管后镇痛VAS评分、发生躁动例数下降(P<0.05)。结论 麻醉诱导前30 min经鼻滴入DEX 1.5 μg·kg^-1可以平稳完成气管插管，同时减少各种不良反应。

Abstract:

OBJECTIVE To investigate the right dose of intranasal dexmedetomidine(DEX) application before anesthesia induction. METHODS All of 120 cases received surgery were randomly divided into four groups, including intranasal 0.9% sodium chloride, 0.5, 1.5, 2.5 μg·kg^-1 DEX groups. Endotracheal intubation and mechanical ventilation were done after anesthesia induction. The patients were sent to the recovery room after operation. Monitoring indicators including intranasal DEX sedation score 30 min later, hemodynamic changes after intubation (mean arterial pressure and heart rate) and the incidence of adverse events, extubation time, pain score and cases of agitation. RESULTS OAA/S score in DEX 0.5, 1.5 and 2.5 μg·kg^-1 group decreased 30 min after intranasal(P<0.05); HR and MAP in DEX 1.5 μg·kg^-1 group decreased 30 min after intranasal(P<0.05); HR and MAP in the control group and DEX 0.5 μg·kg^-1 group increased at immediate intubation, while decreased in DEX 2.5 μg·kg^-1 group(P<0.05). The cases of tachycardia and hypertension in DEX 1.5 μg·kg^-1 group and DEX 2.5 μg·kg^-1 group decreased(P<0.05). The cases of bradycardia and hypotension increased increased in DEX 2.5 μg·kg^-1 group(P<0.05). Extubation time in DEX 2.5 μg·kg^-1 group was extended(P<0.05). The VAS score after extubation and the cases of agitation in DEX 1.5 and 2.5 μg·kg^-1 group were decreased(P<0.05). CONCLUSION Endotracheal intubation can be well done with intranasal DEX 1.5 μg·kg^-1 30 min before anesthesia induction, at the same time all kinds of adverse reactions were reduced.