关键词: 右美托咪啶, 睡眠呼吸暂停, 阻塞性, 插管法, 气管内, 纤维支气管镜, 清醒气管插管, 地佐辛

Abstract: Objective　To observe the efficacy of dezocine combined with different loading dose of dexmedetomidine on awake fiberoptic nasotracheal intubation (AFNI) guided by fiberoptic bronchoscopy in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods　Eighty patients with OSAHS were randomly assigned into 4 groups：the dezocine group (group C)，the dezocine 0.1 mg/kg combined with DEX 0.5 μg/kg group (group D1)，the dezocine 0.1 mg/kg combined with DEX 1 μg/kg group (group D2) and the dezocine 0.1 mg/kg combined with DEX 1.5 μg/kg group (group D3), 20 cases in each group．All patients were given 0.1 mg/kg of dezocine intravenously. The same amount of normal saline was intravenously pumped in group C, and DEX was infused over 10 min by micro-injection pump (group D1: 0.5 μg/kg，group D2: 1 μg/kg，group D3: 1.5 μg/kg) before intubation respectively. DEX 0.5, 1 and 1.5 µg/kg were intravenously pumped in group D1, group D2 and group D3, respectively. Naso-pharyngeal and laryngeal mucous membrane were sprayed with 2% lidocaine for topical anesthesia 5 min before intubation in the four groups. AFNI was performed after the end of administration in the four groups. The heart rate (HR)，mean arterial pressure (MAP)，oxygen saturation (SPO2)，the value of BIS and Ramsay sedation score at entering the OR (T0)，the end of administration (T1) and after intubation (T2) were observed between the four groups. Intubation tolerance, intubation time, patient satisfaction, airway obstruction score and incidence of adverse reactions (bradycardia, respiratory depression, agitation, memory of intubation) were also compared between the four groups. Results　Repeated-measures ANOVA showed that there were interaction between time factor and different intervenient measures on HR, MAP, BIS value and Ramsay sedation score during the experiment (P＜0.05), while there was no interaction with SPO2 (P＞0.05), only time factor affected SPO2 (P＜0.05). Further comparison between the four groups showed that HR and MAP were lower at T1 and T2 in the group D2 than those of the group C (P＜0.05), while HR and MAP were lower at T2 in the group D2 than those in the group D1 (P＜0.05). Compared with the group C and the group D1, the HR and MAP were lower at T1 and T2 in the group D3 (P＜0.05). HR and MAP were lower at T1 and T2 in the D3 group than those in the C group and the D1 group. The incidence of bradycardia was higher in the group D3 than that in the group C (P＜0.05). Compared with the group C and the group D1, the BIS values were lower at T1 and T2, and the Ramsay sedation scores were increased in the group D2 and the group D3 (P＜0.05). The incidence of dysphoria and the remembering of the AFNI, the intubation time were decreased, but the tolerance of AFNI and the patients’ satisfaction with the AFNI were increased in the group D2 and the group D3 than those in the group C and the group D1 (P＜0.05). Conclusion　Dezocine combined with DEX can effectively and safely used for AFNI in patients with OSAHS. In addition, dezocine 0.1 mg/kg combined with DEX 1 μg/kg can not only maintain hemodynamic stability of patients but also reduce the incidence of adverse reactions.

Key words: Dexmedetomidine, sleep apnea, obstructive, intubation, intratracheal, fiberoptic bronchoscopy, awake endotracheal intubation, Dezocine