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目的 观察右美托咪啶用于老年患者纤支镜气管插管的临床效果,并探讨最佳剂量.方法 选择120例65～89岁ASAⅡ或Ⅲ级拟行纤支镜插管的老年患者,采用随机数字表法分为A、B、C、D4组,分别于10 min内输注负荷量为0.2、0.4、0.6、0.8 μg/kg的右美托咪啶,然后四组患者均按0.2 μg/(kg·h)维持,记录入室后基础值(R)、插管前(T1)、入声门即刻(T2)、插管后1 min (T3)、插管后3 min (T4)、插管后10 min (T5)的心率(HR)、平均动脉压(MAP)和OAA/S评分,并记录插管所用时间,评价插管耐受度,满意度评分.结果 四组患者性别、年龄、体重、ASA分级构成之间差异均无统计学意义(P＞0.05).与To时比较,T1～T5时A、B、C、D组OAA/S评分明显降低,B、C、D组MAP明显降低,A组T2～T5心率明显增快,B组T2时心率明显增快,C、D组T1～T5心率明显降低;与A组比较,C、D组T2～T5时OAA/S评分和MAP明显降低;与B组比较,D组T4～T5时刻OAA/S评分明显降低,D组T1～T5时MAP明显降低,D组T2～T5时HR明显降低.B、C、D组患者在插管时间、插管耐受、满意度方面处于同一水平,与A组之间差异均有统计学意义(P均＜0.05).结论 右美托咪啶用于老年患者纤支镜气管插管时,给予负荷量0.4～0.6 μg/kg剂量输注在满足插管要求的同时对老年病人呼吸循环影响小,安全有效,值得临床推广.“,”Objective To evaluate the effect and the optimal dosage of dexmedetomidine during fiberoptic intubation in elder patients.Methods 120 cases from 65 to 89 years of age or grade Ⅲ ASA Ⅱ elderly patients undergoing bronchoscopy intubation were divided into A,B,C and D groups using random number table method.The loading dose of dexmedetomidine for the A,B,C and D groups were 0.2,0.4,0.6,and 0.8 μg/kg,respectively,within 10 min infusion,and then maintained at 0.2 μg/(kg· h).The HR,MAP and OAA/S scores were recorded at burglary baseline (T0),before intubation (T1),Tone door immediately (T2),one minute after intubation (T3),three minutes after intubation (T4),and 10 minutes after intubation (T5).The time of intubation was recorded and the intubation tolerance and satisfaction score were evaluated.Results There were no significant differences in gender,age,body weight and ASA grading between the four groups (P＞0.05).OAA/S scores of groups A,B,C and D at T1～T5 were significantly lower than that of T0;MAP score of B,C and D group at T1～T5 were significantly lower than that of T0.When compared with that at T0,the heart rate at T2～T5 of group A was significantly faster,heart rate at T2 of group B was significantly faster,and heart rate at T1～T5 of group C and D were significantly lower.Compared with group A,OAA/S score and MAP were significantly lower in group C and D at T2～T5.Compared with group B,the OA score of group D at T4～T5 was significantly lower,the MAP of group D at T1～T5 was significantly lower,and the HR of group D at T2～T5 was significantly lower.The intubation time,intubation tolerance and satisfaction were in the same level in group B,C and D,but were significant different from those of group A (all P＜0.05).Conclusion Dexmedetomidine at a loading dose 0.4～0.6 μ g/kg intravenously could be used safely in bronchofibroscopy for elder patients with less cardiovascular and respiratory depression and with more tolerance and satisfaction.