依托咪酯复合右美托咪定用于喉罩全麻下乳腺手术的临床效果观察

Effect of etomidate combined with dexmedetomidine in breast surgery under general anesthesia with laryngeal mask

目的观察依托咪酯复合右美托咪定用于喉罩全麻下乳腺手术的临床效果及安全性。方法选取2017年8月至2018年8月在广东省东莞市人民医院行喉罩全麻下乳腺手术的患者98例,随机分为对照组和观察组,每组49例。对照组单用依托咪酯进行麻醉诱导,观察组采用依托咪酯复合右美托咪定进行麻醉诱导。比较分析两组患者的麻醉效果、呼吸指标、血流动力学指标、意识恢复时间、麻醉清醒时间及不良反应发生情况。结果对照组麻醉有效率为77.55%,明显低于观察组的97.96%,差异有显著性(P<0.05)。两组患者不同时间点的气道峰压和呼气末二氧化碳分压水平差异无显著性(P>0.05)。在喉罩置入时、置入后5min、拔出时、拔出后10min观察组的心率和平均动脉压明显低于对照组,差异有显著性(P<0.05),而血氧饱和度两组比较差异无显著性(P>0.05)。观察组患者呼之睁眼时间、呼吸恢复时间、拔出喉罩时间和定向力恢复时间均明显短于对照组,差异有显著性(P<0.05)。对照组治疗过程中的不良反应发生率为20.41%,明显高于观察组的2.04%,差异有显著性(P<0.05)。结论与单用依托咪酯相比,依托咪酯复合右美托咪定用于喉罩全麻下乳腺手术的麻醉效果较好,血流动力学指标稳定,且拔管时间短,不良反应发生率低,具有较高的临床应用价值。

Objec-tive To compare the extubation time of breast surgery under general anesthesia with etomidate alone and etomidate combined with dexmedetomidine laryngeal mask.Method 98 patients undergoing mammary gland surgery under laryngeal mask general anesthesia from August 2017 to August 201 8 were randomly divided into simple group and compound group with 49 cases in each group.The simple group was given etomidate anesthesia induction,and the compound group was given etomidate combined with dexmedetomidine anesthesia induction.The anesthesia effect,respiratory index,hemodynamics at different time,consciousness recovery time,extubation time and adverse reactions of the two groups were compared and analyzed.Result The effective rate of anesthesia in simple group was77.55%,and that in compound group was 97.96%.The effective rate of anesthesia in simple group was significantly lower than that in compound group(P<0.05).There was no significant difference in the levels of Ppeak and PETCO2 between the two groups at different times(P>0.05).The HR and MAP at Tb,Tc,Td and Te in the composite group were significantly lower than those in the simple group(P<0.05),while the Sp02 had no significant difference(P>0.05).The time of opening eyes,breathing recovery,pulling out laryngeal mask and directional recovery in the composite group were significantly lower than those in the simple group(P<0.05).The incidence of adverse reactions was 20.41%in the simple group and 2.04% in the compound group.The incidence of adverse reactions in the simple group was significantly higher than that in the compound group(P<0.05).Conclusion Compared with etomidate alone,etomidate combined with dexmedetomidine under laryngeal mask general anesthesia has higher anesthetic effect,better hemodynamics,shorter extubation time,lower incidence of adverse reactions,and higher application value.