右美托咪定联合插管型喉罩插管用于颈椎手术麻醉的效果观察  

An Observation of Anesthesia Effect of Dexmedetomidine Combined with Endotracheal Laryngeal Mask Intubation in Cervical Surgery

作　　者：张雪维 孙艳斌[1] 王文玺[1] 安海燕[1] ZHANG Xuewei;SUN Yanbin;WANG Wenxi(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

出　　处：《河北医学》2021年第10期1697-1701,共5页Hebei Medicine

基　　金：河北省承德市科学技术研究与发展计划项目,(编号:202002A013)。

摘　　要：目的:探讨右美托咪定联合气管插管型喉罩(ILMA)对颈椎手术患者麻醉效果及应激反应的影响。方法:2017年2月至2019年2月在我院接受治疗的120例ASAⅠ/Ⅱ级颈椎手术患者,采用简单随机数字表法分为观察组和对照组,每组60例。观察组采用右美托咪定联合ILMA,对照组采用生理盐水联合ILMA。测定两组患者在麻醉前(T0)、插管即刻(T1)、拔管前(T2)以及拔管后5min(T3)的血流动力学指标及炎症应激指标[血清皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)及C反应蛋白(CRP)]的变化。结果:与对照组相比,观察组T1、T2、T3时HR和MAP明显低于对照组,差异具有统计学意义(P<0.05),T0时两组比较无统计学意义(P>0.05);与T0相比,对照组T1、T2、T3时HR和MAP明显升高,差异具有统计学意义(P<0.05);与对照组相比,观察组T1、T2、T3时各应激表达水平均显著降低,差异具有统计学意义(P<0.05);与T0相比,两组患者T1、T2、T3时各应激指标表达水平均显著上调,差异具有统计学意义(P<0.05),T0时两组比较无统计学意义(P>0.05)。结论:在颈椎手术中应用右美托咪定联合气管插管型喉罩可显著降低炎症应激反应,有效的维持血流动力学稳定。Objective:To investigate the effects of anesthesia and stress response of dexmedetomidine combined with endotracheal intubation laryngeal mask(ILMA)in patients undergoing cervical surgery.Methods:120 patients with cervical spine surgery of ASAⅠ/Ⅱfrom February 2017 to February 2019 in our hospital for treatment were divided into observation group and control group by simple random number table method,60 cases in each group.The observation group was treated with dexmedetomidine combined with ILMA,while the control group was treated with normal saline combined with ILMA.Changes of hemodynamic indexes and inflammatory stress indexes[serum cortisol(COR),epinephrine(E),norepinephrine(NE),interleukin-6(IL-6),tumor necrosis factor(TNF-α)and C-reactive protein(CRP)]of two groups of patients before anesthesia(T0),immediate intubation(T1),before extubation(T2)and 5 min after extubation(T3)were compared.Results:Compared with the control group,HR and MAP in the observation group at T1,T2 and T3 were significantly lower than those in the control group,the difference was statistically significant(P<0.05),while there was no statistical significance between the two groups at T0(P>0.05).Compared with T0,HR and MAP in the control group were significantly increased at T1,T2 and T3,with statistical significance(P<0.05).Compared with the control group,the expression levels of stress in observation group at T1,T2 and T3 were significantly decreased,with statistical significance(P<0.05).Compared with T0,the expression levels of stress indicators in 2 groups were significantly up-regulated at T1,T2 and T3,with statistical significance(P<0.05),while there was no statistical significance between the two groups at T0(P>0.05).Conclusion:The application of dexmedetomidine combined with endotracheal intubation laryngeal mask in cervical spine surgery can significantly reduce the inflammatory stress response and effectively maintain hemodynamic stability.

关 键 词：右美托咪定 颈椎手术 插管型喉罩 应激反应 

分 类 号：R614[医药卫生—麻醉学]