右旋美托咪定联合纤维支气管镜在巨大甲状腺肿所致困难气道气管插管中的应用

J4 ›› 2012, Vol. 38 ›› Issue (2): 328-332.

右旋美托咪定联合纤维支气管镜在巨大甲状腺肿所致困难气道气管插管中的应用

李新白¹|刘环秋¹|孟宪瑛²|袁彤¹|韩伟¹|佟倜³|麻海春¹

1.吉林大学第一医院麻醉科|吉林长春 130021；2.吉林大学第一医院甲状腺外科|吉林长春 130021；3.吉林大学第二医院胸外科|吉林长春 130041

收稿日期:2011-12-21 出版日期:2012-03-28 发布日期:2012-03-26
通讯作者: 韩伟(Tel：0431-88782955，E-mail：mzkhanwei@163.com)；孟宪瑛(Tel：0431-88782786，E-mail：xy6823@163.com) E-mail:mzkhanwei@163.com;xy6823@163.com
作者简介:李新白 (1975-)|女|吉林省长春市人|主治医师|在读医学博士|主要从事麻醉基础及临床研究。
基金资助:
吉林省卫生厅科研基金资助课题（2008Z017）


Application of dexmedetomidine combined with fibreoptic bronchoscope for tracheal intubation in difficult airways caused by huge goiter

LI Xin-bai¹,LIU Huan-qiu¹,MENG Xian-ying²,YUAN Tong¹,HAN Wei¹,TONG Ti³,MA Hai-chun¹

1. Department of Anesthesiology,First Hospital,Jilin University,Changchun 130021,China;2.Dpeartment of Thyroid Surgery,First Hospital,Jilin University,Changchun 130021,China;3. Department of Thoracic Surgery,Second Hospital,Jilin University,Changchun 130041,China

Received:2011-12-21 Online:2012-03-28 Published:2012-03-26

摘要/Abstract

摘要：

目的：探讨在巨大甲状腺肿所致的困难气道中应用右旋美托咪定联合纤维支气管镜进行气管插管的有效性。方法：选择巨大甲状腺肿致气管受压移位或变形患者30例，采用计算机随机分为右旋美托咪定组（n=15）和丙泊酚组（n=15）。右旋美托咪定组先给予负荷剂量右旋美托咪定1.0 μg.kg^-1，输注超过10 min后以 0.4 μg.kg^-1.h^-1持续泵人。丙泊酚组先缓慢给予丙泊酚2.0 mg.kg^-1，后以5～8 mg.?kg^-1.h^-1持续泵人。对插管条件进行评估分级；观察患者在插管过程中的反应，如咳嗽分级和患者插管时的舒适度；记录麻醉前（T0）、Rassay评分为4时（T1）、气管插管时（T2）、插管后1 min（T3）及插管后3 min（T4） 5个时间点的心率和血压的变化；记录阿托品和多巴胺的用量以及低氧血症和呼吸抑制等。结果：2组均成功完成纤维支气管镜下气管插管。右旋美托咪定组患者在插管过程中保持良好的自主呼吸，无气道梗阻发生，均能按照指令配合气管插管。丙泊酚组有6例（40.0%）患者出现呼吸道梗阻，11例（73.3%）不能按指令配合气管插管，2组比较差异有统计学意义（P<0.05）。右旋美托咪定组有12例声门开放，3例声门活动；丙泊酚组有7例声门开放，6例声门活动；右旋美托咪定组较丙泊酚组提供较好的插管条件（P<0.05）。在整个插管过程中没有反应或只是轻微的面部表情者，右旋美托咪定组有12例，丙泊酚组有8例，2组比较差异有统计学意义（P<0.05）。右旋美托咪定组患者在T1和T2时刻心率下降更为明显。插管后T3、T4时刻2组患者心率均加快，但右旋美托咪定组患者心率加快不显著，与丙泊酚组比较差异有统计学意义（P<0.05）。在插管过程中右旋美托咪定组未出现低氧血症和气道梗阻，而丙泊酚组3例出现低氧血症，6例出现气道梗阻。结论：在处理巨大甲状腺肿所致的困难气道时，与丙泊酚比较，右旋美托咪定耐受性好，患者呼吸通畅，插管时血流动力学稳定。

关键词: 右旋美托咪定；困难气道；巨大甲状腺肿；丙泊酚；纤维支气管镜

Abstract:

Objective
To study the effectiveness of dexmedetomidine combined with fibreoptic bronchoscope for tracheal intubation in difficult airways caused by huge goiter.Methods Thirty patients with anticipated difficult airways caused by huge goiter were enrolled and randomly divided into dexmedetomidine group (n=15) and propofol group (n=15).The patients in dexmedetomidine group received a loading dose of dexmedetomidine (1.0 μg?kg-1),infused over 10 min,then pumped at continuous rate of 0.4 μg.kg^-1.h^-1.The patients in propofol group received a loading dose of 2.0 mg.kg^-1 and pumped at continuous rate of 5-8 mg.kg^-1.h^-1. The intubating conditions were graded by a scoring system; the reactions to intubation such as coughing and patient tolerance were observed;the heart rates and mean arterial blood pressures (MABP) at different time points of baseline(T0),Rassay score 4(T1),intubating(T2),1 min after intubation (T3) and 3 min after intubation (T4) were recorded;adverse events and haemodynamic support were observed.Results All the patients in two groups were performed successfully with fibreoptic intubation.The patients in dexmedetomidine group could keep better spontaneous breathing without respiratory depression,and were able to command and cooperate tracheal intubation,while in propofol group 11 patients (73.3%) could not cooperate tracheal intubation (P<0.05).With respect to intubation scores in propofol group,there were 7 cases of vocal cord opening and 3 cases of vocal cord movement;while in dexmedetomidine group,there were 12 cases in vocal cord opening and 3 cases in vocal cord moving.Compared with propofol group,the patients in dexmedetomidine group had more favorable intubation scores of vocal cord movement (P<0.05).With respect to no reaction or slight grimacing of reaction to intubation comfort score,there were 8 cases in propofol group and 12 cases in dexmedetomidine group,and there was significant difference (P<0.05).The patients in dexmedetomidine group experienced fewer airway events and less heart rate response to intubation than those in propofol group (P<0.05).Conclusion Compared with propofol in management of difficult airways caused by huge goiter,dexmedetomidine has better tolerance,and preserves a patient airway,and has more stable haemodynamic response to intubation.


Key words: dexmedetomidine;difficult airway;huge goiter;propofol;fibreoptic bronchoscope

中图分类号:

李新白|刘环秋|孟宪瑛|袁彤|韩伟|佟倜|麻海春. 右旋美托咪定联合纤维支气管镜在巨大甲状腺肿所致困难气道气管插管中的应用[J]. J4, 2012, 38(2): 328-332.

LI Xin-bai,LIU Huan-qiu,MENG Xian-ying,YUAN Tong,HAN Wei,TONG Ti,MA Hai-chun. Application of dexmedetomidine combined with fibreoptic bronchoscope for tracheal intubation in difficult airways caused by huge goiter[J]. J4, 2012, 38(2): 328-332.

[1]	周颖,高孟飞,朱慧勇. 间充质干细胞干性维持信号通路的研究进展[J]. 吉林大学学报(医学版), 2013, 39(3): 638-642.
[2]	李红，陈永浩，龚红君. 右美托咪定对肾癌根治术患者围术期炎性细胞因子和肾功能的影响[J]. 吉林大学学报(医学版), 2013, 39(3): 588-591.
[3]	李海波，刘行，孙美花,梁建民. 孕期至幼年期低水平铅暴露仔鼠海马锌离子平衡的变化及其发育期海马神经元的损伤[J]. 吉林大学学报(医学版), 2013, 39(3): 521-528.
[4]	谢波，沈梅，叶文鑫，舒彦，梁臻，张心男. 依帕司他联合行为疗法治疗女性糖尿病膀胱的临床疗效评价[J]. 吉林大学学报(医学版), 2013, 39(3): 597-600.
[5]	李辉,赵丽晶,杜宇,杨铁铮，李国峰,陈亮,支晨阳,李娜,周建华. 结肠安栓联合舒血宁对溃疡性结肠炎大鼠的治疗作用及其机制[J]. 吉林大学学报(医学版), 2013, 39(3): 488-493.
[6]	张洪长，王恩鹏，陈新，唐燕，王洪鑫，王炫策，许新. 人参皂苷Re对UVC辐射损伤细胞的保护作用[J]. 吉林大学学报(医学版), 2013, 39(3): 507-511.
[7]	武国东，王素侠，及志勇，张舒岩. 急性心力衰竭大鼠B型钠尿肽水平与肝功能的关系[J]. 吉林大学学报(医学版), 2013, 39(3): 517-520.
[8]	陈宣男，全首祯. NDM1基因常规PCR与荧光定量PCR检测方法的建立及其检测结果比较[J]. 吉林大学学报(医学版), 2013, 39(3): 625-629.
[9]	周超熙,于滨,赵斌,马志强,赵文河,于跃明. 直肠癌环周切缘病理学检测判断中低位直肠癌患者预后的临床价值[J]. 吉林大学学报(医学版), 2013, 39(3): 601-604.
[10]	周广宇，韩雪梅，金玲. 神经精神狼疮患者影像学表现与自身抗体水平和预后的关系[J]. 吉林大学学报(医学版), 2013, 39(3): 609-614.
[11]	周建英，田勇韩青,贺庆,程凯亮,李幼琼. 影像学三维重建技术在寰椎立体模型建立及性别鉴定中的应用[J]. 吉林大学学报(医学版), 2013, 39(3): 605-608.
[12]	沈煜，沈惠良，方秀统. 老年股骨颈骨折患者关节置换术后死亡危险因素分析[J]. 吉林大学学报(医学版), 2013, 39(3): 574-577.
[13]	王宗谦，卢新星. 终末期肾病患者抑郁程度与生存质量各个维度之间的关系[J]. 吉林大学学报(医学版), 2013, 39(3): 615-619.
[14]	李树春，王槐. 影响美托洛尔治疗效果的药物基因组学研究进展[J]. 吉林大学学报(医学版), 2013, 39(2): 423-426.
[15]	胡源，贾卉，姜瑞，李京，刘涛涛. 不同验光方法对中年患者屈光状态的检测及其临床意义[J]. 吉林大学学报(医学版), 2013, 39(2): 363-366.