右美托咪定预输注对双管喉罩置入时血流动力学影响的研究

Effects of different doses of dexmedetomidine on the hemodynamics changes when inserted with Supreme laryngeal mask airway before anesthesia

目的观察右美托咪定（dexmedetomidine，DEX）预输注对双管喉罩置入时血流动力学和机体应激反应的影响。方法选择择期行全麻手术的患者60例，ASA分级Ⅰ～Ⅱ级，采用随机数字表法将其分为对照组（C组）、DEXl组（D1组）和DEX2组（1）2组），每组各20例。患者术前未使用任何药物，C组给予等容量的生理盐水，D1组和D2组麻醉前10min分别给予DEX0．5、1μg·kg-1（均用生理盐水稀释至4mg·L-1）静脉输注，输注时间均为10min。10min后以依托咪酯乳剂0．2mg·kg-1、舒芬太尼0．15μg·kg-1、阿曲库铵0．5mg·kg。静脉诱导。3组患者均用利多卡因喷壶充分咽后壁表面麻醉下双管喉罩置入，根据患者体重范围结合患者的身体情况，选择适宜型号的一次性双管喉罩，常规仔细检查双管喉罩气囊是否漏气，在罩体背侧及前侧涂抹少量石蜡油，以减少双管喉罩在插入过程中的阻力。记录3组置入双管喉罩前、置入双管喉罩即刻及置入双管喉罩后1rain心率和平均动脉压（MAP），比较3组不同时点的MAP、心率的变化率。结果D1组和D2组置入双管喉罩前、置入双管喉罩即刻及置入双管喉罩后1rain血流动力学变化明显小于C组（P〈0．05）；与D1组比较，D2组置入双管喉罩前、置入双管喉罩即刻及置入双管喉罩后1rain的心率变化率均较大（P〈0．05）。结论麻醉开始前静脉预输注DEX0．5μg·kg-1和1μg·kg-1联合充分咽后壁表面麻醉能够明显抑制置入双管喉罩所引起的血流动力学变化。其中静脉预输注DEX0．5μg·kg-1的患者双管喉罩置入时血流动力学更稳定，而预输注DEX1μg·kg-1的患者在充分咽后壁表面麻醉下，心率往往受到抑制。

Objective To observe the effecte of different doses of dexmedetomidine （DEX） on hemodynamics changes and stress response when inserted with Supreme laryngeal mask airway （LMA Suprem） before anesthesia. Methods A total of 60 ASAⅠ～Ⅱ patients who were scheduled for general anesthesia were randomly divided into three groups （n = 20） ： a control group （Group C） , a DEX intravenous infusion 1 group （Group D1 ） and a DEX intravenous infusion 2 group （Group D2 ）. Patients did not received any medication before surgery. Groups D1 and D2 were administrated with 0. 5 and 1 μg·kg-1 of DEX （ diluted to 4 mg·kg-1with normal saline） over 10 min, which Group C was adminis- trated with the equal volume of normal saline. Then, patients underwent intravenous induction using 0.2 mg·kg-1eto- midate, 0.15 μg·kg-1 sufentanil and 0.5 mg·kg-1 atracurium. All patients were inserted with LMA Supreme under pharyngeal surface anesthesia of lidocaine. Based on body weight and basic physical condition, proper types of Supreme LMA were chosen. The changes of heart rate （HR） and mean blood pressure （MAP） before, immediately after and 1 min after LMA Supreme insertion were recorded. Results Compared with Group C, Groups D1 and D2 showed remark- ably decreased hemodynamic changes before, immediately and 1 rain after LMA Supreme insertion （P 〈 0.05）. However, Compared with Group D1, the change of HR was increased in Group 1）2 before, immediately and 1 rain after LMA Supreme insertion （P 〈 0.05）. Conclusions DEX （0.5 or 1μg·kg-1 ） intravenous infusion before anesthesia combined with pharyngeal surface anesthesia can significantly suppress hemodynamic changes after the LMA Supreme inser-tion. Administration of 0.5μg·kg-1 DEX can successfully reduce the hemodynamic changes. HR is suppressed after 1 μg·kg-1 DEX infusion under pharyngeal surface anesthesia.