右美托咪定对口腔颌面外科清醒插管患者吞咽功能的影响

doi:10.19439/j.sjos.2021.02.019

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (2): 206-209.doi: 10.19439/j.sjos.2021.02.019

右美托咪定对口腔颌面外科清醒插管患者吞咽功能的影响

董翔, 劳蔚, 刘锦星, 纪均

上海交通大学医学院附属第九人民医院麻醉科,上海 200011

收稿日期:2020-02-27 修回日期:2020-08-20 出版日期:2021-04-25 发布日期:2021-05-11
通讯作者: 纪均,E-mail: lordjjun@163.com
作者简介:董翔（1980-）,男,硕士,主治医师,E-mail: dongxiang0816@163.com

Effect of dexmedetomidine on swallowing function of patients undergoing awake intubation in oral and maxillofacial surgery

DONG Xiang, LAO Wei, LIU Jin-xing, JI Jun

Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2020-02-27 Revised:2020-08-20 Online:2021-04-25 Published:2021-05-11

摘要/Abstract

摘要： 目的:观察右美托咪定用于口腔颌面外科患者清醒插管的镇静效果及其对吞咽功能的影响。方法:选择 50 例口腔颌面外科手术需行清醒插管的患者,随机分成 2 组（每组 25 例）,即右美托咪定（DEX）组和咪达唑仑+芬太尼（MF）组。插管前 20 min,DEX 组给予右美托咪定 1.0 μg/kg,MF 组给予生理盐水 50 mL;插管前 5 min,DEX 组给予生理盐水 10 mL,MF 组给予咪达唑仑 0.02 mg/kg和枸橼酸芬太尼 2.0 μg/kg。观察不同时间点（诱导前 T0、插管前 T1、插管后 T2）患者心率（HR）、平均动脉压（MAP）、呼吸频率（RR）、血氧饱和度（SpO₂）,并进行 Ramsay 镇静评分和吞咽时间测定。采用 SPSS 20.0 软件包进行数据分析。结果:T0 时间点,2 组患者 HR、RR、MAP、SpO2 及吞咽时间测定比较,无统计学差异（P>0.05）。T1 时间点,与 MF 组相比,DEX 组患者HR下降,吞咽时间缩短,具有统计学差异（P<0.05）;RR、MAP、SpO₂、Ramsay 评分无统计学差异（P>0.05）。T2 时间点,与 MF 组相比,DEX 组患者 HR下降,Ramsay 评分升高,具有统计学差异（P<0.05）;RR、MAP、SpO₂ 无统计学差异（P>0.05）。DEX 组患者在 T1 时间点与 T0 时间点相比,HR 下降,吞咽时间延长,具有统计学差异（P<0.05）;RR、MAP、SpO₂ 无统计学差异（P>0.05）。T2 时间点与 T1 时间点相比,Ramsay 评分降低,具有统计学差异（P<0.05）。结论:右美托咪定能够为清醒插管患者提供良好的镇静效果,并且对患者吞咽反射未造成明显的抑制作用,提高了清醒气管插管的安全性。

关键词: 右美托咪定, 口腔颌面外科, 清醒插管, 镇静, 吞咽功能

Abstract: PURPOSE: To evaluate the sedative effect of dexmedetomidine in awake intubation and its influence on swallowing function. METHODS: Fifty patients with awake intubation in oral and maxillofacial surgery were randomly divided into two groups: dexmedetomidine(DEX) group and midazolam+fentanyl(MF) group. 15 min before intubation, patients in DEX group were intravenously given 50 mL dexmedetomidine(1.0 μg/kg), and others in MF group were intravenously given 50 mL normal saline respectively. 5 min before intubation, 10 mL normal saline was given to DEX group, 0.02 mg/kg midazolam and 2.0 μg/kg fentanyl were given to MF group. HR, MAP, RR, SpO₂, Ramsay sedation score and swallowing time were measured at different time points (before induction-T0, before intubation-T1 and after intubation-T2). SPSS 20.0 software package was used for data analysis. RESULTS: There was no significant difference in HR, RR, MAP, SpO₂ and swallowing time between the two groups at T0 time point(P>0.05). Compared with MF group, HR significantly decreased and swallowing time significantly shortened(P<0.05). RR, MAP, SpO₂ and Ramsay sedation score had no significant difference (P>0.05) in DEX group at T1 time point. Compared with MF group, HR significantly decreased and Ramsay sedation score significantly increased(P<0.05); RR, MAP and SpO₂ had no significant difference (P>0.05) in DEX group at T2 time point. Compared with T0 time, HR significantly decreased and swallowing time significantly prolonged (P<0.05); RR, MAP and SpO₂ had no significant difference(P>0.05) in DEX group at T1 time point. Compared with T1 time, Ramsay sedation score decreased with significant difference(P<0.05) at T2 time point. CONCLUSIONS: Dexmedetomidine can provide good sedative effect for patients with awaking intubation without obvious inhibitory effect on swallowing reflex of patients, improving the safety of intubation.

Key words: Dexmedetomidine, Oral and maxillofacial surgery, Awake intubation, Sedation, Swallowing function

中图分类号:

R782.05

董翔, 劳蔚, 刘锦星, 纪均. 右美托咪定对口腔颌面外科清醒插管患者吞咽功能的影响[J]. 上海口腔医学, 2021, 30(2): 206-209.

DONG Xiang, LAO Wei, LIU Jin-xing, JI Jun. Effect of dexmedetomidine on swallowing function of patients undergoing awake intubation in oral and maxillofacial surgery[J]. Shanghai Journal of Stomatology, 2021, 30(2): 206-209.

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右美托咪定对口腔颌面外科清醒插管患者吞咽功能的影响

Effect of dexmedetomidine on swallowing function of patients undergoing awake intubation in oral and maxillofacial surgery

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