单次输注右美托咪定在经皮扩张气管切开术中的临床应用

发布时间：2018-11-13 15:55

【摘要】：目的:观察使用右美托咪定(DDM)施行监测性麻醉管理(MAC)用于口腔颌面肿瘤外科手术患者经皮扩张气管切开术(PDT)中的临床效果。方法:选择术前预防性行PDT的口腔颌面肿瘤手术患者38例,随机分成2组,每组19例。D组静脉注射DDM 0.5μg/kg,10 min泵完;M组静脉注入咪达唑仑2 mg+芬太尼1μg/kg。给药后,2组患者局部浸润麻醉后行PDT。观察记录给药前(T0)、用药后(T1)、切皮时(T2)、置入气管切开插管时(T3)各时点患者MAP、HR和Sp O2;记录气管切开过程中患者术中Ramsay评分、呛咳、呼吸抑制、心血管反应等不良事件,术后24 h随访患者对PDT不良回忆情况。结果:D组T1,T2时MAP,HR明显低于T0时,而M组T3时MAP和HR高于T0时(P0.05);T1、T2和T3时D组MAP和HR明显分别低于M组(P0.05);T0~T3时点D组呛咳、呼吸抑制低于M组(P0.05)。结论:在PDT中采用监测性麻醉管理,与咪达唑仑复合芬太尼比,单次输注右美托咪定更有利于患者的血流动力学稳定,减少呛咳和呼吸抑制。
[Abstract]:Objective: to observe the clinical effect of dexmetomidine (DDM) on monitoring anesthesia management (MAC) in patients with oral and maxillofacial neoplasms undergoing percutaneous dilatation tracheotomy (PDT). Methods: Thirty-eight patients with oral and maxillofacial neoplasms undergoing preoperative prophylactic PDT were randomly divided into two groups: group D (n = 19) received intravenous injection of DDM 0.5 渭 g / kg 10 min, group M received midazolam 2 mg fentanyl (1 渭 g / kg) intravenously. After administration, two groups of patients were treated with PDT. after local infiltration anesthesia. MAP,HR and Sp O _ 2 were observed before (T _ 0), after medication (T _ 1), skin incision (T _ 2) and tracheotomy (T _ 3). The adverse events such as Ramsay score, cough, respiratory inhibition and cardiovascular reaction during tracheotomy were recorded. The adverse events of PDT were followed up 24 hours after operation. Results: MAP,HR in group D was significantly lower than that in group T _ 1 and T _ 2, while MAP and HR in group M were higher than those in group T _ 3 (P0.05), MAP and HR in group D were significantly lower than those in group M at T _ 1, T _ 2 and T _ 3 (P0.05). At the time point of T0~T3, cough and respiratory inhibition in group D were lower than those in group M (P 0.05). Conclusion: compared with midazolam combined with fentanyl, a single infusion of dexmetidine in PDT is more beneficial to hemodynamics stability and reduce cough and respiratory inhibition in PDT than midazolam combined with fentanyl.
【作者单位】：南京大学医学院附属口腔医院;南京大学医学院附属鼓楼医院;
【分类号】：R614

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