国际麻醉学与复苏杂志   2017, Issue (12): 7-7
    
右美托咪定用于睡眠呼吸暂停低通气综合征 纤维鼻咽镜检查的可行性研究
赵林林, 刘鹤, 杨建平, 张月英, 曹君利, 齐敦益1()
1.徐州医科大学附属医院
Feasibility and validity of dexmedetomidine as a drug to induce sleep for fibrolaryngoscopy assay in patients with sleep apnea-hypopnea syndrome: a randomized controlled trial
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摘要:

目的 观察右美托咪定(dexmedetomidine, Dex)诱导睡眠下纤维鼻咽镜检查的可行性。 方法 睡眠呼吸暂停低通气综合征(sleep apnea-hypopnea syndrome, SAHS)患者88例,采用随机数字表法分为两组(每组44例):丙泊酚组(P组)和Dex组(D组)。P组患者检查前静脉注射丙泊酚2 mg/kg,D组患者检查前15 min内静脉泵注Dex 1 μg/kg,记录给药前(T0)、患者入睡即刻(T1)、内镜操作时(T2)以及检查结束时(T3)的MAP、HR、SpO2,记录入睡时间、The Observer's Assessment of Alertness/Sedation Scale(OAA/S)改良评分、内镜检查时间、可唤醒时间、辅助通气例数、患者和术者满意度、内镜检查假阳性例数。 结果 与D组比较,P组患者T1时的MAP和SpO2均降低(P<0.05);内镜检查时间、可唤醒时间明显延长,面罩通气发生率以及内镜检查假阳性率较高,但其入睡时间明显缩短(P<0.05)。 结论 Dex作为一种新型诱导睡眠药相比丙泊酚更适用于纤维鼻咽镜检查。

关键词: 右美托咪定; 睡眠呼吸暂停低通气综合征; 纤维鼻咽镜检查
Abstract:

Objective To evaluate the feasibility and efficacy of dexmedetomidine (Dex) induced sleep for fibrolaryngoscopy in patients with sleep apnea-hypopnea syndrome. Methods Eighty-eight inpatients with sleep apnea-hypopnea syndrome (SAHS) were randomly divided into 2 groups: Propofol group (group P) and Dex group(group D). Each group had 44 cases. In group P, patients were intravenously injected with 2 mg/kg propofol, while in group D, 1 μg/kg dex was intravenously administered with a pump over 15 min. The MAP, HR, and SpO2 of patients were recorded before administration of the drug(T0), immediately after falling asleep(T1) and after fibrolaryngoscopy operation(T2), and by the end of fibrolaryngoscopy assay(T3). Additional parameters were also analyzed, such as, time to fall asleep, observer's assessment of alertness/sedation scale(OAA/S), time of endoscopic examination, time to wake up after examination, the number of patients required mask ventilation, the satisfaction of patients and examiners, and false-positive cases of fibrolaryngoscopy assay. Results Compared with patients in group D, patients in group P fell asleep faster, exhibited lower MAP and SpO2 immediately after falling asleep (P<0.05), but longer time to finish fibrolaryngoscopy and longer time to wake up after examination. More group P patients required mask ventilation and needed further assessment to exclude false-positive signs in fibrolaryngoscopy. Conclusions Dex may be a better intervention to induce sleep for fibrolaryngoscopy assay of sleep apnea-hypopnea syndrome in term of safety and validity of the examination.

Key words: Dexmedetomidine; Sleep apnea-hypopnea syndrome; Fibrolaryngoscopy