右美托咪定联合气管插管型喉罩在颈椎损伤病人麻醉中的应用  

Application of Dexmedetomidine combined with Endotracheal Intubation Laryngeal Mask in Anesthesia for Patients with Cervical Spine Injury

作　　者：孙艳斌[1] 孙淑红 王文玺[1] 张雪维 王馨[1] 周宏杨 胡杰[1] SUN Yanbin(Chengde Central Hospital, Hebei Chengde 067000, China)

机构地区：[1]河北省承德市中心医院麻醉科,河北承德067000 [2]河北省承德市妇幼保健院妇科,河北承德067000

出　　处：《河北医学》2019年第8期1340-1344,共5页Hebei Medicine

基　　金：河北省承德市科技计划项目,(编号:20151012)

摘　　要：目的:探究右美托咪定联合插管型喉罩(ILMA)对颈椎损伤病人的麻醉效果及应激反应的影响.方法:2014年12月至2017年12月在我院接受治疗的120例颈椎损伤患者被随机分为对照组和观察组,每组60例.观察组采用右美托咪定静脉泵注、联合ILMA,对照组采用咪达唑仑静脉泵注联合ILMA.比较两组的临床指标,麻醉药物泵注前(T0)、注药后1min(T1)、插管即刻(T2)、插管成功后1min(T3)的血流动力学指标以及应激激素指标的变化.结果:两组病人的插管总成功率分别为96.67%、91.67%,两组的插管总成功率、插管时间、插管前阿托品使用情况无显著差异(P>0.05),观察组首次插管成功率、耐受率显著高于对照组(P<0.05),插管后艾司洛尔使用率、躁动发生率显著低于对照组(P<0.05).两组HR、MAP、SpO2在T0、T1、T2、T3时刻先下降后升高(P<0.05),组间比较T0时刻差异无统计学意义,T1、T2、T3时刻差异有统计学意义(P<0.05),观察组波动幅度更小,更为稳定;两组的Ramsay评分先升高后下降,观察组镇静状态优于对照组;两组去甲肾上腺素、肾上腺素在T0、T1时刻无显著差异,T2、T3时刻观察组显著低于对照组(P<0.05),观察组波动更小、更为稳定;以上指标两组在不同时间点、组间、不同时间、组间·不同时间交互效应比较差异均存在统计学意义(P<0.05).结论:右美托咪定联合ILMA能提高颈椎损患者麻醉的首次插管成功率和耐受性,有利于维持血流动力学平稳,减轻患者的应激反应.Objective: To analyze the anesthesia effect of dexmedetomidine combined with ILMA in treating patients with cervical spine injury. Methods: 120 patients with cervical spine injury from December 2011 to December 2017 were randomly divided into control group and observation group, each group with 60 cases. The control group was treated with midazolam combined with ILMA, while observation group was treated with endotrachealintubation anesthesia combined with ILMA. The clinical indexes, changes of hemodynamic parameters and s tress hormone indexes of before anaesthesia (T0), 1 min after anaesthesia (T1), during intubation (T2) and 1 min after successful intubation(T3) of two groups were compared. Results: The total success rate of intub ation of the observation group and contr ol group was 96.67% and 91.67% respectively. There was no significant difference in the total success rate, intubation time and atropine use before intubation between the two groups (P>0.05). The success rate of the first intubatio n and tolerance rate in the observation group were significantly higher than those in the control group (P<0.05), The rate of use of esmolol and agitatio n after intubation were significantly lower than those of the control group (P<0.05). HR, MAP, SpO 2 in the two groups at T0, T1, T2, T3 were decreased first and then increased, there was no significant difference in T0 between groups, but there was significant difference in T1, T2 and T3 (P<0.05), the fluctuation of the observation group was smaller and more stable;The Ramsay score of the two groups were increased first and then decreased, and the sedation state of the observation group was better than that of the control group;there was no significant difference in norepinephrine and epinephrine between the two groups at T0 and T1, while the observation group was significantly lower at T2 and T3 than the control group (P<0.05), the fluctuation of the observation group was smaller and more stable;The interaction effect of the above indexes between two groups at dif

关 键 词：右美托咪定 颈椎损伤 血流动力学 应激反应 

分 类 号：R614[医药卫生—麻醉学]