比较右美托咪啶与舒芬太尼分别联合丙泊酚对喉罩置入条件的影响

Comparison of dexmedetomidine versus sulfentanil respectively combining with propofol in laryngeal mask airway insertion

目的:喉罩的置入需要一定的麻醉深度和对气道反射的抑制,为寻找一种最佳的辅助药物,本研究拟比较右美托咪啶和舒芬太尼分别联合丙泊酚对喉罩置入条件的影响。方法:选择择期小型上、下肢骨科手术或小型泌尿外科手术患者90例,ASA分级I或II级,年龄18~58岁,随机分为两组,静脉给予盐酸右美托咪啶1μg·kg^(-1)(D组,n=45)或给予枸橼酸舒芬太尼0.2μg·kg^(-1)(S组,n=45),给药时间均大于2分钟,诱导用药均使用丙泊酚2 mg·kg^(-1),90 s后置入喉罩,记录诱导前(T0)、诱导后30 s(T1)、置入喉罩后1 min(T2)、3 min(T3)、5 min(T4)、10 min(T5)的心率、呼吸频率、无创血压、血氧饱和度、BIS值、呼吸暂停发生率及持续时间,并对置入喉罩时发生的不良反应如呛咳、恶心或其它体动记录并进行评分。结果:D组42例喉罩置入条件评分<2分(93.3%),S组40例喉罩置入条件评分<2分(88.9%)。两组喉罩置入前后的血压变化差异无统计学意义,D组T1时刻心率下降,与基础值和S组比较差异有统计学意义,置入喉罩过程中的不良反应发生率相似。但与D组比较,S组发生呼吸暂停的例数更多,呼吸暂停时间更长,与S组相比,D组呼吸频率明显增快。结论:右美托咪啶可以替代阿片类药物作为喉罩置入的辅助用药,并且能够保留自主呼吸。

Objective:Laryngeal mask airway(LMA)insertion requires anesthesia and suppression of airway reflexes.We compared dexmedetomidine and fentanyl in combination with propofol for insertion of LMA,In searching of an optimal drug.Methods:90 patients of ASA class I or II undergoing minor orthopedic surgery of lower limbs or minor urological surgery were randomly divided into two groups of 45 each.Group D received dexmedetomidine 1 mg·kg-1 and group S received sulfentanil 0.2 mg·kg-1 intravenously over 2 minutes.For induction,propofol 2 mg·kg-1 was given IV and 90 seconds later LMA was inserted.We observed HR,respiratory rate(RR),MAP,SpO 2,BIS,and apnea time before induction,30 seconds after induction,1,3,5 and 10 minutes after insertion of LMA.Adverse event to LMA insertion like coughing or any other movement were noted and scored.Results:42(93.3%)patients of group D and 40(88.9%)patients of group S had LMA insertion score of<2.Adverse events to insertion of LMA and hemodynamic variables were comparable in the both groups.Number of patients developing apnoea was larger and apnoea times were longer in group S compared with group D.When compared to group F,group D showed an increased respiratory rate.Conclusion:Dexmedetomidine can be a comparable alternative to sulfentanil as an adjuvant to propofol for providing optimum insertion conditions for LMA and preservation of respiration.