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目的:探讨右美托咪定对喉癌经皮穿刺气管切开术中芬太尼镇静效果的影响。方法:2010年4月至2012年10月将收注射42例喉癌患者行术前经皮穿刺气管切开,采用随机数字表法将患者分为观察组(右美托咪定联合芬太尼)和对照组(芬太尼),每组各21例。记录术前(T0)、药物注射结束(T1)、扩张气管置入气管切开套管(T2)、手术结束后(T3)四个时相点的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2)、呼吸频率(RR);监测T0、T1时检测警觉/镇静评分(OAA/S评分),并记录气管切开过程中不良事件。结果:对照组和观察组T0、T1OAA/S评分分别为5、(4.11±0.47)分和5、(4.23±0.53)分,P>0.05;两组T1OAA/S评分均较同组T0显著下降(P<0.05)。观察组T1、T2、T3与T0时的MAP、HR、Sp O2、RR相比,差异无统计学意义(P>0.05);观察组T2、T3时MAP、HR、RR明显低于对照组(P<0.05),但各时相点Sp O2与对照组比较,差异无统计学意义(P>0.05)。结论:喉癌患者行经皮穿刺气管切开术时,使用右美托咪定联合小剂量芬太尼可减少躁动反应及呛咳,且无呼吸、循环抑制。
Objective: To investigate the effect of dexmedetomidine on sedation of fentanyl in percutaneous tracheotomy of laryngeal carcinoma. Methods: From April 2010 to October 2012, 42 patients with laryngeal cancer who underwent percutaneous tracheotomy were randomly divided into observation group (dexmedetomidine plus fentanyl ) And control group (fentanyl), 21 cases in each group. The mean arterial pressure (MAP) and heart rate (HR) were recorded at the four time points before surgery (T0), end of drug injection (T1), intratracheal tracheotomy tube (T2) (Sp O2) and respiratory rate (RR). Alertness / sedation scores (OAA / S scores) were monitored at T0 and T1, and adverse events during tracheotomy were recorded. Results: The scores of T0 and T1OAA / S in the control group and the observation group were 5 (4.11 ± 0.47) and 5 (4.23 ± 0.53) points respectively, P> 0.05. The T1OAA / S scores of both groups were significantly lower than those of the same group (P <0.05). There was no significant difference in MAP, HR, Sp O2 and RR between T1, T2, T3 and T0 in observation group (P> 0.05). MAP, HR, RR in observation group were significantly lower than those in control group P <0.05). However, there was no significant difference between Sp O2 and control group at each time point (P> 0.05). Conclusion: Percutaneous tracheotomy in patients with laryngeal cancer, the use of dexmedetomidine combined with low-dose fentanyl can reduce agitation and cough, and no respiratory and circulatory depression.