帝视可视内窥镜联合右美托咪定在老年高血压患者气管插管中的应用

Application of Discopo combingd with dexmedetomidine to tracheal intubation stress level in elderly patients with hypertension

目的探讨帝视可视内窥镜(Discopo)联合右美托咪定在老年高血压患者全麻气管插管中的应用价值。方法选择老年高血压患者120例,随机分为Discopo组(D组)、Discopo联合右美托咪定组(DD组)、Macintosh喉镜组(M组)、Macintosh喉镜联合右美托咪定组(MD组),每组30例。MD组和DD组于麻醉诱导前静脉泵注右美托咪定0.6μg/kg,M组和D组静脉泵注等容量的生理盐水;麻醉诱导后,相应组别分别使用Discopo或Macintosh喉镜实施经口气管内插管。观察和记录在麻醉诱导前(T0)、诱导后插管前(T1)、插管后1 min(T2)、3 min(T3)和5 min(T4)时各组患者的收缩压、舒张压、心率,于T0、T2及T4检测各组患者的血浆肾上腺素、去甲肾上腺素浓度。统计插管一次成功率、插管时间和插管并发症发生率。结果4组均顺利完成气管内插管,D组及DD组一次插管成功率高于M组及MD组(P<0.05),且插管时间短于M组及MD组(P<0.05),D组及DD组未发生并发症,M组插管后咽痛3例,MD组插管后咽痛2例。4组间心率、收缩压及舒张压比较,差异有统计学意义(P<0.05),与其他组比较,DD组患者T2时血压和心率均明显降低。4组不同时间点心率、收缩压及舒张压比较,差异有统计学意义(P<0.05),除DD组,其他3组患者T2的血压和心率均明显高于T1,且M组T3时仍明显升高。4组血浆肾上腺素及去甲肾上腺素浓度比较,差异有统计学意义(P<0.05),DD组T2和T4的血浆肾上腺素及去甲肾上腺素浓度低于其他组,而MD组低于M组。4组不同时间点肾上腺素及去甲肾上腺素比较,差异有统计学意义(P<0.05),除DD组,其他3组的肾上腺素及去甲肾上腺素浓度在T2均明显升高,且M组T4的肾上腺素及去甲肾上腺素浓度仍高于基础值(T0)。结论 Discopo一次插管成功率高且对患者损伤小,Discopo联合右美托咪定对老年高血压患者气管插管应激水平具有保护作用。

Objective To investigate the application value of the visual endoscope（ Discopo） combined with dexmedetomidine in general anesthesia and tracheal intubation for elderly patients with hypertension. Methods A total of 120 elderly patients with hypertension were randomized into Discopo group（ Group D）,Discopo combined with dexmedetomidine group（ Group DD）,Macintosh laryngoscope group（ Group M） and Macintosh laryngoscope combined with dexmedetomidine group（ Group MD）,with 30 cases in each group. Before anesthesia induction,Group MD and Group DD were intravenously pumped with dexmedetomidine（ 0. 6 μg / kg）,while Group D and Group M with same volume of normal saline. After anesthesia induction,orotracheal intubation with Discopo or Macintosh was performed in the corresponding groups. Systolic blood pressures,diastolic blood pressures and heart rates of the patients in the four groups were observed and recorded before anesthesia induction（ T0）,after induction but before intubation（ T1）,at 1 minute（ T2）,3 minutes（ T3） and 5 minutes（ T4） after intubation.The concentrations of plasma epinephrine and norepinephrine were detected in each group at T0,T2 and T4. The success rate of one-time intubation,duration of intubation and incidence of intubation-related complications were also counted. Results Endotracheal intubation was completed successfully in the four groups. Group D and Group DD obtained higher success rates of one-time intubation and less durations of intubation compared to Group M or Group MD（ P〈0. 05）. No complications occurred in Group D or Group DD,3 case of pharyngalgia occurred in Group M,and 2 cases in Group MD. There were significant differences in heart rate,systolic blood pressure and diastolic blood pressure among four groups（ P〈0. 05）. At T2,the blood pressure and heart rate of Group DD significantly decreased compared to the other groups.There were significant differences in heart rate,systolic blood pressure and diastolic blood pressure at each time point among four groups（ P〈0. 05）. Except for Group DD,the blood pressure and heart rate of the other three groups at T2 were significantly higher than those at T1,and the blood pressure and heart rate of Group M remained significantly high at T3. There were significant differences in the concentrations of plasma epinephrine and norepinephrine among four groups（ P〈0. 05）. At T2 and T4,the concentrations of plasma epinephrine and norepinephrine in Group DD were lower than those in the other groups,and the concentrations in Group MD were lower than those in Group M. There were significant differences in the concentrations of epinephrine and norepinephrine at each time point among four groups（ P〈0. 05）. Except for Group DD,the concentrations of epinephrine and norepinephrine of the other three groups significantly increased at T2,and the concentrations of epinephrine and norepinephrine of Group M at T4 were significantly higher than the base value（ T0）. Conclusion Discopo can obtain a high success rate of one-time intubation and is less harmful to the patients. Discopo combined with dexmedetomidine has a protective effect on the level of stress in elderly patients with hypertension during tracheal intubation.