中文摘要：

目的探讨右美托咪定（dexmedetomidine,Dex）清醒镇静对颈椎受限患者经鼻盲探插管血压和心率的影响,阐明Dex清醒镇静经鼻盲探插管的安全性及实用性。方法选择因颈椎骨折入院,拟行骨折切开复位内固定手术的患者60例,ASAⅠ～Ⅱ级,男女不限,年龄18～55岁,除外高血压、心脏传导阻滞及心率低于65次/min的患者。60例患者根据手术顺序号随机分为4组,表麻组（L组）、右美托咪定＋表麻组（DL组）、咪达唑仑＋舒芬太尼＋表麻组（MSL组）和右美托咪定＋咪达唑仑＋舒芬太尼＋表麻组（DMSL组）,每组15例。结果手术历时2.5～3 h。4组患者组内鼻咽腔表麻、插管时与术前比较,血压均升高（P〈0.01）;L组插管时与表麻时比较,血压进一步升高（P〈0.01）;组间插管时DL组、DMSL组与L组比较降低（P〈0.05）。4组患者组内心率变化,L组、MSL组鼻咽腔表麻、插管时与术前比较,心率显著升高（P〈0.01）;插管时与表麻时比较,心率进一步增高（P〈0.01）。DL组、DMSL组鼻咽腔表麻、插管时与术前比较,心率显著下降（P〈0.01）。4组患者组间比较,表麻时DL组、DMSL组心率明显低于L组（P〈0.01）,也低MSL组（P〈0.01）,DMSL组心率最低。插管时DL组、MSL组、DMSL组心率均低于L组（P〈0.01）,DMSL组心率最低。结论右美托咪定可以减少鼻咽腔表麻、气管插管等刺激性操作引起的血压上升、心率加快的作用,加入少量咪达唑仑、舒芬太尼,患者血流动力学更平稳,舒适配合,是颈椎受限患者保留自主呼吸最理的想插管方法。

英文摘要：

Objective To investigate the influence of dexmeditomidine on blood pressure and heart rate during conscious-sedative nasal intubation in patients with cervical movement limitation,thus to evaluate the safety and feasibility of dexmiditomidine in induced conscious-sedation with nasal-blind-intubation.Methods Sixty patients with cervical vertebral fracture scheduled for open reduction with internal fixation were randomly divided into four groups according to operation order： mucosal anesthesia group with lidocaine（Group L）;dexmedetomidine and mucosal anesthesia group（Group DL）;midazolam,sufentanil and mucosal anesthesia group（Group MSL）;and dexmedetomidine,midazolam,sufentanil and mucosal anesthesia group（Group DMSL）.Results There was significant elevation of BP during pharyngonasal mucosal anesthesia or intubation compared with pre-operative baseline in all the four groups（P0.01）.BP was also significantly raised during intubation compared with that during mucosal anesthesia in Group L（P0.01）.However,the BP were significantly suppressed in during intubation in Group DL and Group DMSL group,compared with that in Group L（P0.05）.There were significant elevation of HR during pharyngonasal mucosal anesthesia or intubation Group L and MSL when comparing with baseline,with significantly further elevation during intubation when comparing with that during pharyngonasal mucosal anesthesia（P0.01）.However,the HR was significantly suppressed during pharyngonasal mucosal anesthesia and intubation in Group DL and DMSL（P0.01）.Furthermore,the HR were significantly lower during mucosal anesthesia in Group DL and DMSL than those in Group L and MSL（P0.01）,with the lowest HR in Group DMSL.And the HR were significantly lower during intubation in Group DL,MSL and DMSL than that in Group L（P0.01）,with the lowest HR in Group DMSL.Conclusion dexmedetomidine alleviates the BP and HR elevation during pharyngonasal mucosal anesthesia or intubation,which can be enhanced by low dose midazolam and suf