右美托咪定联合七氟醚麻醉在困难气道中的应用

目的观察右美托咪定联合七氟醚麻醉用于困难气道中的可行性及安全性。方法选取2018年1-11月于中国人民解放军联勤保障部队第910医院择期全麻手术前存在困难气道的患者120例,按随机数字表法分为DS组、DR组、D组、R组,每组30例。DS组采用右美托咪定联合七氟醚麻醉DR组采用右美托咪定联合瑞芬太尼麻醉,D组采用右美托咪定联合表面麻醉,R组采用瑞芬太尼联合表面麻醉。比较4组患者入室时(T₀)、麻醉插管前(T₁)、插管即刻(T₂)、插管后1 min(T₃)、插管后5 min(T₄)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO₂);比较4组患者插管过程中呛咳、躁动等不良反应和插管知晓情况。结果 DS组和DR组T₁、T₂、T₃、T₄时MAP、HR均低于T₀时差异有统计学意义(P<0.05);DR组T₁时SpO₂低于T₀时,差异有统计学意义(P<0.05);D组、R组T1时MAP、HR低于T₀时,T₂、T₃、T₄时MAP、HR明显高于T₀时,差异有统计学意义(P<0.05)。T₁时DR组MAP、HR、SpO2明显低于DS组、D组、R组差异有统计学意义(P<0.05)。T₂、T₃、T₄时D组、R组的MAP、HR明显高于DS组、DR组差异有统计学意义(P <0.05);DR组与DS组MAP、HR比较差异均无统计学意义(P>0.05)。DS组患者插管过程中呛咳、躁动发生率明显低于DR组、D组、R组,差异有统计学意义(P <0.05);DS组、DR组插管知晓率明显低于D组、R组差异有统计学意义(P <0.05)。结论右美托咪定联合七氟醚麻醉用于困难气道安全有效,血流动力学平稳,不良反应发生率低。

Application of dexmedetomidine combined with sevoflurane anesthesia in difficult airway

Objective To observe the feasibility and safety of dexmedetomidine combined with sevoflurane anesthesia in difficult airways.Methods 120 cases of patients with difficult airway in elective surgery admitted to the 910 st Hospital of the Joint Logistics Support Force of PLA from January to November 2018 were selected,according to the random number table,they were divided into DS group,DR group,D group,R group,30 cases in each group.DS group was anesthetized with dexmedetomidine combined with sevoflurane,DR group was anesthetized with dexmedetomidine combined with remifentanil,D group was anesthetized with dexmedetomidine combined with surface anesthesia,R group was anesthetized with remifentanil combined with surface anesthesia.The mean arterial pressure(MAP),heart rate(HR) and blood oxygen saturation(SpO2) of the 4 groups of patients entering the room(T0),before anesthesia intubation(T1),immediately after intubation(T2),1 minute after intubation(T3),and 5 minutes after intubation(T4) were compared.The adverse reactions such as coughing and restlessness during intubation and the awareness of intubation were compared among the 4 groups.Results The MAP and HR at T1, T2,T3,and T4 in the DS group nd DR group were lower than T0(P <0.05);The SpO2 at T1 in the DR group was lower than T0(P <0.05);the MAP and HR at T1 in D group and R group were lower than T0,the MAP and HR at T2, T3,T4 were significantly higher than T0,the differences were statistically significant(P <0.05).At T1,the MAP,HR,and SpO2 in the DR group were significantly lower than those in the DS group,D group,and R group(P <0.05).At T2, T3,and T4,the MAP and HR of the D group and R group were significantly higher than those of the DS group and DR group(P <0.05);There was no significant difference in MAP and HR between the DR group and the DS group(P> 0.05).The incidence of coughing and restlessness during intubation of the DS group was significantly lower than that of the DR group,D group,and R group(P <0.05);The awareness rate of intubation in the DS group and DR group was significantly lower than that in the D group and R group(P <0.05).Conclusion Dexmedetomidine combined with sevoflurane anesthesia is safe and effective for difficult airways,with stable hemodynamics and low incidence of adverse reactions.