右美托咪定慢诱导联合脑电双频指数监测在困难气道插管中的应用

Clinical value of dexmedetomidine combined with BIS monitoring for amnesia analgesia and slow induction in patients with difficult airway

目的:研究右美托咪定联合脑电双频指数(BIS)监测健忘镇痛慢诱导技术在困难气道插管中的应用。方法:选取某院全麻择期手术患者60例,采用随机数字表法分为研究组(YM组)和对照组(C组),每组30例。研究组采用右美托咪定诱导,对照组采用咪达唑仑联合氟哌利多诱导。比较2组患者麻醉诱导前(T_(0))、麻醉诱导后(T_(1))、插管后即刻(T_(2))、手术结束(T_(3))的心率(HR)、平均动脉压(MAP)、BIS,比较2组患者诱导前(D0)、插管后3 min(D_(1))、插管后15 min(D_(2))的皮质醇(Cor)、去甲肾上腺素(NA)、肾上腺素(AD)、多巴胺(DA)、β-内啡肽(β-EP)水平,记录2组患者喉镜暴露分级、术毕镇静评分、术后1、4 h疼痛评分、术中舒芬太尼用量、一次插管成功率、插管时间及不良反应发生率。结果:2组患者T_(1)、T_(2)、T_(3)时MAP和BIS均明显降低,且YM组低于C组(P<0.05);2组患者D_(1)、D_(2)时NA、AD及β-EP均显著降低,且YM组低于C组(P<0.05);YM组镇静评分及术后疼痛评分低于C组,舒芬太尼用量少于C组,插管时间短于C组,差异均有统计学意义(P<0.05)。结论:使用右美托咪定麻醉诱导联合BIS监测麻醉深度,能安全有效的处理气道插管问题,对困难气道的患者是一种有效的诱导药物。

Objective:To study the effect of dexmedetomidine combined with bispectral index(BIS)monitoring for slow induction of amnesia analgesia on general anesthesia in patients with difficult airway.Methods:60 patients undergoing elective surgery under general anesthesia in a hospital were selected and randomly divided into two groups:dexmedetomidine group(YM group)and control group(C group),with 30 cases in each.The YM group was induced by dexmedetomidine,and the C group was induced by midazolam combined with droperidol.Heart rate(HR),mean arterial pressure(MAP)and BIS before induction(T_(0)),after induction(T_(1)),immediately after intubation(T_(2)),and at the end of operation(T_(3))of the two groups were compared.Cortisol(Cor),norepinephrine(NA),epinephrine(AD),dopamine(DA)andβ-endorphin(β-EP)levels before induction(D0),3 minutes(D_(1))and 15 minutes(D_(2))after intubation were compared between the two groups.Laryngoscopic exposure grade,postoperative sedation score,pain score 1 hour and 4 hours after surgery,intraoperative sufentanil dosage,success rate of single intubation,intubation time,incidence of postoperative adverse reactions were recorded in the two groups.Results:Compared with those before induction,MAP and BIS were significantly decreased in both groups at T_(1),T_(2) and T_(3),with YM group's being lower than those in C group(P<0.05).Compared with those before induction,NA,AD andβ-EP levels in both groups were significantly decreased at D_(1) and D_(2),with YM group's being lower than those in C group(P<0.05).Compared with C group,the postoperative sedation score and pain score after surgery in YM group were lower,the dosage of sufentanil was smaller,and the intubation time was shorter,the differences being statistically significant(P<0.05).Conclusion:Anesthesia induction with dexmedetomidine combined with BIS monitoring of anesthesia depth can safely and effectively manage difficult airway,with high patient satisfaction.