摘要
目的:探讨Shikani喉镜联合右美托咪定(DEX)慢诱导用于急诊饱胃患者清醒气管插管的可行性,并评价其临床效果及优势。方法:40例急诊饱胃患者,随机分为Shikani喉镜气管插管组(S组)和Macintosh喉镜气管插管组(M组)。2组均采用2%利多卡因行咽喉腔及气管内表麻,10 min静脉泵入DEX负荷量1μg/kg,继以1μg/(kg·h)维持至适宜镇静程度,再分别使用Shikani喉镜(S组)和Macintosh喉镜(M组)行气管插管。评估气管插管条件和患者对气管插管的耐受性及配合程度;记录气管插管次数、时间以及包括心血管反应、呼吸抑制、口咽腔损伤等不良反应或并发症的发生情况。结果:与M组比较,S组气管插管条件的恶心呕吐降低,且耐受性提高(P<0.05)。S组的1次插管成功率(95.0%)高于M组(70.0%),平均插管时间少于M组,口咽腔黏膜出血创伤的发生率也较M组少,差异均有统计学意义(均P<0.05)。S组无明显呼吸抑制及对插管的不良记忆,无剧烈的插管心血管反应。结论:DEX镇静复合上呼吸道表麻下,Shikani喉镜引导急诊饱胃患者的清醒气管插管,较普通Macintosh喉镜插管更简便有效、患者舒适性强、不良反应少。
Objective To investigate the feasibility of Shikani optical stylet combined dexmedetomidine （DEX） for orotracheal intubation with in the emergency patients with consciousness and a full stomach. Methods Forty emergency patients with a full stomach were randomly assigned to Shikani optical stylet group （group S, n = 20） or Macintosh laryngoscopy group （group M, n = 20）. All the patients received intravenous DEX with a loading dose of 1 μg/kg for 10 minutes, and then followed by a continuous infusion at a rate of 1 μg/（kg.h） until the desired depth of sedation was reached. After topical anaesthesia of the upper airway with 2% lidocaine of 150 rag, orotracheal intubation was performed using Shikani optical styler in group S and Macintosh laryngoscopy in group M. Intubation conditions, patient tolerance to intubation, and level of patient cooperation were assessed. Time of intubation, frequency of intubation, and adverse effects or complications were observed and recorded. Results As compared with group M, the rate of nausea and vomiting was lower and patient tolerance increased in group S （P 〈 0.05 ）. The one-time success rate of intubation was significantly higher, time of intubation was shorter, and incidence of oropharyngeal injuries was lower in group S than in group M （95.0% vs. 70.0% for the success rate, P 〈 0.05）. No obvious respiratory depression, recall of bad memory, and severe cardiovascular reactions were found in group S. Conclusions Under sedation with DEX combined with topical anesthesia of the upper airway in full-stomach patients, orotracheal intubation directed by Shikani optical styler for emergency patients with consciousness and a full stomach is simpler and more effective and has fewer adverse reactions than intubation with Macintosh laryngoscopy, and the patients feel more comfortable.
出处
《实用医学杂志》
CAS
北大核心
2013年第15期2429-2432,共4页
The Journal of Practical Medicine
基金
佛山市医学科学技术研究计划课题(编号:201008108)
关键词
右美托咪啶
饱胃
气管插管
清醒
SHIKANI喉镜
Dexmedetomide
A full stomach
Endotracheal intubation
Consciousness
Shikani optical styler
