右美托咪定联合喉罩对颅内动脉瘤栓塞术患者气管插管应激性反应影响

The Effect of Dexmedetomidine Combined with Laryngeal Mask on Tracheal Intubation Stress Response in Patients with Intracranial Aneurysm Embolization

目的:观察右美托咪定联合喉罩应用于颅内动脉瘤栓塞术患者对气管插管期间血流动力学影响。方法:选择本院2014年1月-2015年10月行颅内动脉瘤栓塞术患者80例,根据随机数字表法分为两组,每组40例。观察组于诱导前泵注右美托咪定1μg·kg-1,时间10min,然后静注芬太尼3μg·Kg^(-1),丙泊酚(1.5-2.0)mg·Kg^(-1),罗库溴铵50mg;对照组静注咪达唑仑2mg,芬太尼3μg·Kg^(-1),丙泊酚(1.5-2.0)mg·Kg^(-1),罗库溴铵50mg,两组患者均面罩给氧,肌松满意后插入大小适宜喉罩,记录两组患者气管插管不同时刻血流动力学相关指标进行统计学分析。结果:两组于T_0、T_1、T_4时刻MAP水平比较均无显著统计学差异,观察组于T_2、T_3时刻MAP和HR均低于对照组。结论:右美托咪定联合喉罩应用于颅内动脉瘤栓塞术患者血流动力学更为稳定,气管插管期间应激性反应更低,具有重要临床价值。

Objective： To investigate the effect of dexmedetomidine combined with laryngeal mask airway on hemodynamics during tracheal intubation in patients with intracranial aneurysm embolization. Methods： Select 80 cases patients who needed intracranial aneurysm embolization in our hospital from January in 2014 to October in 2015 year were enrolled in this study. Then according to random table method all patients were divided into two groups with 40 cases in each group. The induction scheme： before induction observation group took infusion of dexmedetomidine 1μg·Kg^-1 with 10rain, and intravenous injection fentanyl 3μg·Kg^-1 , propofol（ 1.5 - 2.0） mg ·Kg^-1 , roeuronium 50mg; control group accepted intravenous injection of midazolam 2mg, fentanyl 3μg·Kg^-1 , propofol （ 1. 5 - 2. 0 ） mg·Kg^-1, roeuronium 50rag. Then two groups of patients were given oxygen masks and accept appropriate size insertion of laryngeal mask when muscle relaxants. Record the related index of hemodynamies between two groups of patients at different time to statistical analysis. Results： Two groups＇ MAP levels in To, TI , Ta had no statistically significant difference. Observation group＇ MAP and HR were respectively lower than the control group＇. Conclusions：The hemodynamics of patients with intracranial aneurysm embolization after dexmedetomidine combining with laryngeal mask airway during tracheal intubation is more stable and cortisol levels are lower,tracheal intubation stress response is lower, so it has important clinical value.