右美托咪定联合Supreme喉罩麻醉在老年乳腺癌根治术中的临床应用

Clinical application of dexmedetomidine combined with LMA supreme general anesthesia in elderly patients undergoing radical mastectomy

目的探讨右美托咪定联合Supreme喉罩全身麻醉在老年乳腺癌根治术患者中的临床效果、安全性及优势。方法选择60例择期行乳腺癌根治术、ASAⅠ-Ⅱ级、年龄65-75岁的老年患者,随机分为Supreme喉罩组（S组n=30）和右美托咪定联合Supreme喉罩组（D组n=30）,分别记录麻醉诱导前（T0）、诱导后（T1）、喉罩置入即刻（T2）、切皮时（T3）及喉罩拔除即刻（T4）各时点患者的平均动脉压（MAP）、心率（HR）;计算患者全身麻醉药物总用量、苏醒及拔除喉罩时间;观察术中返流误吸,苏醒期躁动、呛咳、寒战情况及术后声嘶、咽痛等不良反应发生率;评价术后1、2、6 h的视觉模拟评分（VAS）。结果与麻醉诱导前基础值（T0）相比,S组MAP、HR在T1时点显著降低（P〈0.05）,T3时点显著增高（P〈0.05）,T2、T4时点略增高但差异无统计学意义（P〉0.05）;D组MAP在T1、T2、T3、T4时点变化不显著,HR在T1、T2、T3时点显著下降（P〈0.05）。与D组相比,S组MAP在T1时点显著降低（P〈0.05）,在T3时点显著增高（P〈0.05）,在T2、T4时点略增高,但差异无统计学意义（P〉0.05）,HR在T2、T3时点显著增高（P〈0.05）,HR在T1、T4时点变化不显著（P〉0.05）。与S组相比,D组全身麻醉药用量明显减少（P〈0.05）,苏醒时间和拔除喉罩时间明显缩短（P〈0.05）,苏醒期躁动、呛咳、寒战、术后咽痛发生率明显降低（P〈0.05）。两组患者均无术中返流误吸及术后声嘶发生。D组术后1 h、2 h VAS评分明显小于S组（P〈0.05）,术后6 h无明显差异（P〉0.05）。结论右美托咪定联合Supreme喉罩用于老年乳腺癌根治术全身麻醉,具备血流动力学平稳,全身麻醉药用量少,苏醒和拔除喉罩时间短及术后不良反应少、舒适度高的优势。

Objective To evaluate the clinical efficacy and safety of dexmedetomidine combined with LMA Supreme general anesthesia in elderly patients undergoing radical mastectomy.Methods Sixty patients aged 65-75 years,ASA grade Ⅰ-Ⅱ undergoing elective radical mastectomy were randomly allocated in LMA Supreme group（Group S） and dexmedetomidine combined with LMA Supreme（Group D） with 30 cases each.The SBP,DBP,HR were recorded before anesthesia induction（T0）,after induction（T1） immediately after inserting LMA（T2）,on skin incision（T3）,immediately after removing LMA（T4）.The dosage of general anesthetics,the time of revival and extubation were calculated.Intraoperative regurgitation and pulmonary microaspiration,agitation bucking and ague at awakening,postoperative hoarseness and pharyngodynia were documented.VAS was evaluated after1,2 and 6 hours of operation.Results Compared with the baseline value at T0,the SBP,DBP,HR in group S were significantly decreased at T1（P〈0. 05） and significantly increased at T3（P〈0. 05）.The HR was significantly decreased at T1,T2,T3 in group D（P〈0. 05）.Compared with group D,the SBP and DBP in group S were significantly lower at T1（P〈0. 05）;and the SBP,DBP,HR were higher at T3（P〈0. 05）.No intraoperative regurgitation and pulmonary microaspiration and postoperative hoarseness were found in both groups.Compared with group S,the dosage of general anesthetics and the time of revival and extubation in group D were significantly shortened and the agitation bucking ague at awakening and postoperative pharyngodynia were significantly decreased（P〈0. 05）.The VAS in group D at 1,2 hours after operation was lower than that in group S（P〈0. 05）.Conclusion Dexmedetomidine combined with LMA Supreme general anesthesia has a satisfactory and safe effect with better hemodynamic stability,less consumption of anesthetics and faster consciousness recovery in elderly patients undergoing radical mastectomy.