右美托咪定复合双管喉罩在颅内动脉瘤栓塞术的临床应用

Clinical application of Dexmedetomidine combined with proseal laryngeal mask airway in intracranial aneurysm embolization

目的评价应用右美托咪定复合双管喉罩在颅内动脉瘤栓塞术中的效果。方法选择2015年2月~2017年2月于我院行颅内动脉瘤栓塞术的86例患者,随机分为实验组和对照组,各43例。实验组诱导麻醉前给予右美托咪定负荷量镇静治疗,之后微量泵持续泵入至手术结束前20 min,麻醉诱导后插入双管喉罩;对照组诱导麻醉前给予等量生理盐水静脉注射,麻醉诱导后插入双管喉罩。比较两组泵注右美托咪定或生理盐水前(T_0)、诱导前(T_1)、置入喉罩前(T_2)、置入喉罩后1 min(T_3)、股动脉插管时(T_4)、动脉瘤栓塞时(T_5)、术毕时(T_6)、拔出喉罩前(T_7)、拔出喉罩后1 min(T_8)的血压、心率;记录停药后自主呼吸恢复时间、拔出喉罩时间、定向力恢复时间;记录喉罩拔除时患者的不良情况以及每例瑞芬太尼用药总量以及术中分别给予血管活性药物的种类和次数。结果与T_0时相比,实验组T_3时,对照组T_3、T_5和T_8时的HR、SBP和DBP均明显升高(P<0.05),实验组T_1、T_2、T_4、T_6和T_7时,对照组T_2、T_4、T_6和T_7时的HR、SBP和DBP均明显降低(P<0.05)。实验组T_1~T_8时的HR、SBP和DBP均显著低于对照组(P<0.05)。实验组的苏醒时间和拔管时间显著短于对照组,术中不良情况、瑞芬太尼用量和血管活性药物应用次数均显著低于对照组(P<0.05)。结论颅内动脉瘤栓塞术中应用右美托咪定复合双管喉罩,患者的血流动力学较为稳定,苏醒时间和拔管时间较短,值得推广。

Objective To evaluate the efficacy of Dexmedetomidine combined with proseal laryngeal mask airway in in- tracranial aneurysm embolization.Methods From February 2015 to February 2017,60 patients underwent intracranial a- neurysm embolization in our hospital were selected and randomly divided into the control group and the study group,43 cases in each group.The study group was given Dexmedetomidine before anesthesia induction and continuous intra- venous infusion until 20 minutes before the operation finished;the proseal laryngeal mask airway was given after anes- thesia induction.The control group was given the same amount of normal saline,the proseal laryngeal mask airway was given after anesthesia induction.The heart rate （HR） and blood pressures （SBP and DBP） before injection （T0）,before intubation （T1）,before intubation （T2）,l rain after intubation （T3）,the moment of puncture （T4）,the moment of embolization （T5）,the end of the operation （T6）,before extubation （T7）,l rain after extubation （T8） were evaluated.The recovery time of spontaneous breathing,the time of pulling out the laryngeal mask and the recovery time of the directional force after stopping drug were recorded.The adverse reactions of patients with laryngeal mask alrway,the amount of Remifentanil used in each case and the types and times of vasoactive drugs were recorded.Results The level of HR,SBP and DBP in the study group at Tz and the control group at T3,T5,T8 was higher than that at To （P〈0.05）.The HR,SBP and DBP in the study group at T1,T2,T4,T6 and T7 and the control group at T2,T4,T6 and T7 was lower than that at T0 （P〈0.05）.The HR,SBP and DBP in the study group at T1 to Ts were significantly lower than that in the control group （P〈0.05）.The recovery time and extubation time in the study group was significantly shorter than that in the control group,the incidence of adverse drug reactions during the operation,the dosage of Remifentanil,and vasoactive drugs use in the study group was significantly lower than that in the control group （P〈0.05）.Conclusion Dexmedetomidine combined with proseal laryngeal mask airway in the embolization of intracranial aneurysms,the patient＇s hemodynamics is stable,the recovery time and extubation time is short,it is worth promoting.