摘要： 目的 探讨不同剂量艾司氯胺酮联合右美托咪定对清醒盲探经鼻气管插管口腔颌面外科手术患者的镇静效果。方法 选取2021年1月至2022年12月我院口腔颌面外科需清醒经鼻气管插管的口腔颌面外科手术患者90例作为研究对象。其中颞下颌关节紊乱需进行颞下颌关节盘松解复位锚固术46例，髁突骨折需进行切开复位内固定术44例。采用随机数字表法将患者随机分为A组（右美托咪定0.8 μg/kg+艾司氯胺酮0.2 mg/kg）、B组（右美托咪定0.8 μg/kg+艾司氯胺酮0.4 mg/kg）和C组（右美托咪定0.8 μg/kg+艾司氯胺酮0.6 mg/kg），每组30例。各组均静脉输注10 min并完成气管插管。记录患者给药前（T0）、气管插管前（T1）、插入气管导管即刻（T2）平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SPO₂），同时记录插管过程中Ramsay评分和不良刺激反应；术后24 h随访调查患者舒适度、满意度、有无记忆情况。结果 与A组比较，T1时B组、C组MAP和HR均显著升高（均P<0.05）；但T2时B组、C组MAP和HR显著降低（均P<0.05）。与A组、B组比较，C组T1、T2时SPO₂显著降低，而Ramsay评分显著升高（均P<0.05）。与A组比较，B组、C组呛咳、体动、MAP>120%发生率明显减少（均P<0.05）；而C组气道梗阻发生率高于A组、B组（P<0.05）。与A组比较，B组、C组舒适度、满意度和对插管无记忆比例明显提高（均P<0.05）。结论 艾司氯胺酮（0.4 mg/kg）联合右美托咪定（0.8 μg/kg） 10 min内静脉输注可作为清醒盲探经鼻气管插管推荐的镇静方案。

艾司氯胺酮联合右美托咪定对清醒盲探经鼻气管插管患者的镇静效果

张明明, 赵晓春

中国医科大学口腔医学院·附属口腔医院麻醉科, 辽宁省口腔疾病重点实验室, 沈阳 110002

收稿日期:2023-02-21出版日期:2023-08-30发布日期:2023-08-07
通讯作者:赵晓春E-mail:xiaochunzhao119@163.com
作者简介:张明明(1987-),女,主治医师,硕士.
基金资助:国家自然科学基金（82173904）


关键词: 艾司氯胺酮, 右美托咪定, 清醒盲探气管插管, 镇静
Abstract: Objective To discuss the sedative effect of different doses of esketamine combined with dexmedetomidine in patients undergoing awake blind nasal intubation assisted by oral and maxillofacial surgery. Methods The study participants were 90 patients who underwent oral and maxillofacial surgery in our hospital and required awake nasal intubation from JAN 2021 to DEC 2022. Among them,46 patients with temporomandibular joint disorders required disc repositioning surgery (mini-screw anchor),and 44 with condylar fracture required open reduction and internal fixation surgery. The patients were randomly divided into groups A (dexmedetomidine 0.8 μg/kg+ esketamine 0.2 mg/kg),B (dexmedetomidine 0.8 μg/kg+ esketamine 0.4 mg/kg),and C (dexmedetomidine 0.8 μg/kg+ esketamine 0.6 mg/kg) using a random number table method,with 30 patients in each group. All groups of patients were intravenously infused for 10 minutes. The patients were completed tracheal intubation. Heart rate (HR),mean arterial pressure (MAP),pulse oximetry (SPO₂),Ramsay score,and adverse stimulation reactions were recorded before administration of drugs (T0),before intubation (T1),and at intubation (T2). The follow-up observations at 24 h post-surgery were noted (no memory of intubation,comfort and satisfaction with intubation). Results Compared with group A,the MAP and HR of groups B and C were significantly increased at T1 (P < 0.05) but significantly decreased at T2 (P < 0.05). Compared with groups A and B,the SPO₂ of group C decreased significantly at T1 and T2,while the Ramsay score increased significantly (P < 0.05). Compared with group A,the incidence of coughing,movement,and MAP >120% in groups B and C was significantly reduced (all P < 0.05). Meanwhile,the incidence of airway obstruction was higher in group C than in groups A and B (P < 0.05). Compared with group A,the comfort and satisfaction with intubation,and proportion of patients with no memory of intubation in groups B and C were significantly improved (all P < 0.05). Conclusion Dexmedetomidine (0.8 μg/kg) combined with esketamine (0.4 mg/kg) intravenously infused within 10 minutes can be used as a sedation scheme for awake blind nasal tracheal intubation.
Key words: esketamine, dexmedetomidine, awake blind intubation, sedation
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