3种静脉诱导方法联合右美托咪啶用于高龄患者喉罩全身麻醉的比较

Comparison of three intravenous induction methods combined with dexmedetomidine for laryngeal mask airway anesthesia in elderly patients

目的探讨3种静脉诱导方法联合右美托咪啶(DEX)对高龄患者喉罩全身麻醉(简称全麻)诱导期置入喉罩条件、血流动力学及应激反应的影响。方法选择欲行中小手术喉罩全麻诱导的120例高龄患者,70～95岁,ASAⅡ～Ⅲ级,按随机数字表法分为E、P、PE 3组,每组40例。各组均预先给予DEX 0.5μg/kg,E组给予依托咪酯0.2mg/kg;P组给予丙泊酚2.0mg/kg;EP组给予丙泊酚1.0mg/kg和依托咪酯0.1mg/kg混合药液;给药时间均大于2min。观察各组诱导期血流动力学变化情况,并对喉罩置入条件进行评分(下颌活动度评分法和呛咳/体动评分法,大于2分则评价为置入效果不满意),比较各组患者肌阵挛、注射痛及呼吸暂停等不良反应发生情况。结果与入室后基础值比较,PE、E组血流动力学变化不明显,两组组间组内比较差异无统计学意义(P>0.05);P组血压、心率下降明显,组间组内比较差异有统计学意义(P<0.05)。下颌活动度评分法和呛咳/体动评分法大于2分者P组分别为2、1例,E组分别为6、14例,PE组分别为4、3例。喉罩置入满意率P组为92.5%(37/40),E组为50.0%(20/40),PE组为82.5%(33/40)。P、PE组满意率明显高于E组(P<0.05)。结论依托咪酯与丙泊酚配伍用于高龄患者喉罩全麻诱导,能够得到稳定的血流动力学水平和满意的喉罩置入条件。

Objective To investigate the effect of the condition of laryngeal mask airway insertion,hemodynamic change and stress reaction of three intravenous induction methods combined with dexmedetomidine(DEX)on laryngeal mask airway anesthesia in elderly patients.Methods A total of 120 elderly(70-95 years old)patients undergoing midium or small surgery withⅡorⅢASA physical status were involved,then they were divided into three groups(group E,P and PE)with 40 cases in each group.Each group received DEX 0.5μg/kg in advance,group E received etomidate 0.2 mg/kg,group P received propofol 2.0 mg/kg,group PE received propofol 1.0 mg/kg combine with etomidate 0.1 mg/kg,dosing time was more than 2 min.The hemodynamic changes were observed,the laryngeal mask placement conditions were scored(mandibular activity score and cough/body motility score,all the scores being more than 2 point was evaluated as unsatisfactory effect),the incidences of myoclonus,injection pain and apnea were compared.Results Compared with the baseline,the hemodynamic changes of group PE and E were not obvious,there was no significant difference between the two groups(P>0.05);blood pressure and heart rate of group P decreased significantly,the difference was statistically significant(P<0.05).There were 2 and 1 cases respectively with the mandibular activity score being more than 2 point and cough/body motility score being more than 2 point in group P,6 and 14 cases respectively in group E,4 and 3 cases respectively in group PE.The satisfaction rate of laryngeal mask placement was 92.5%(37/40)in group P,50.0%(20/40)in group E,and 82.5%(33/40)in group PE.The satisfaction rates of group P and PE were higher than that of group E(P<0.05).Conclusion The combination of etomidate and propofol for the induction in the laryngeal mask airway anesthesia can achieve stable hemodynamic level and satisfactory laryngeal mask placement conditions.