右美托咪定联合氯胺酮与咪达唑仑麻醉诱导用于困难气道插管中的价值分析

目的:探讨右美托咪定联合氯胺酮与咪达唑仑麻醉诱导在困难气道插管中的应用价值。方法:选取2016年1月至2018年10月我院收治的80例困难气道患者进行回顾性研究,根据插管顺序将受试者分为对照组和研究组两组,每组40例。对照组患者给予氯胺酮与咪达唑仑进行麻醉诱导,研究组患者在对照组的基础上联合右美托咪定进行麻醉诱导。比较两组麻醉前(T1)、纤支镜经过会厌时(T2)、声门时(T3)、插管即刻(T4)、插管后60 s(T5)、插管后180 s(T6)、插管后300 s(T7)时的平均动脉压(mean arterial pressure,MAP)、心率(Heart rate,HR)、血氧饱和度(Blood oxygen saturation,SpO_2)及Ramsay评分变化,并监测T1、T4及T6时间点去甲肾上腺素(Norepinephrine,NE)、肾上腺素(epinephrine,E)及皮质醇(Cortisol,Cor)水平及不良反应的发生情况。结果:两组不同时间点Sp O_2比较无统计学差异(P0.05),但研究组患者在T3-T7时间点的MAP、HR显著低于对照组,Ramsay评分显著高于对照组(P0.05)。两组患者T1时的NE、E及Cor水平比较无统计学差异(P0.05),但研究组T4及T6时NE、E及Cor水平均显著低于对照组(P0.05)。研究组患者呛咳、恶心、躁动及呼吸抑制的发生率均显著低于对照组(P0.05)。结论:与氯胺酮联合咪达唑仑相比,右美托咪定联合氯胺酮与咪达唑仑对心血管系统影响小,安全性更高,患者应激反应较低,在困难气道插管麻醉诱导中具有较高的应用价值。

Value Analysis of Dexmedetomidine Combined with Ketamine and Midazolam for Anesthesia Induction in Difficult Airway Intubation

ABSTRACT Objective: To explore application value of dexmedetomidine combined with ketamine and midazolam for anesthesia induction in difficult airway intubation. Methods: Eighty patients with difficult airway admitted to our hospital from January 2016 to October 2018 were enrolled and retrospectively studied. The subjects were divided into two groups according to the intubation sequence: 40 patients in each group. The control group were given ketamine and midazolam for anesthesia induction, the study group on the basis of this combination of dexmedetomidine for anesthesia induction. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO₂) pre-anesthesia (T1), at bronchoscopy after epiglottis (T2), glottis (T3), intubation immediately (T4), 60 s after intubation (T5), and 180 s after intubation (T6), the Ramsay score at 300 s (T7) after intubation, and the levels of norepinephrine (NE), epinephrine (E), and cortisol (Cortisol, Cor) at T1, T4, and T6 were compared between two groups. Results: There was no significant difference in the SpO₂ between the two groups at different time points (P>0.05), but the MAP and HR of the study group were significantly lower than those of the control group at the T3-T7 time point, and the Ramsay score was significantly higher than that of the control group(P<0.05). There was no significant difference in the levels of NE, E and Cor between the two groups at T1 (P>0.05), but the levels of NE, E and Cor in the study group were significantly lower than those in the control group at T4 and T6 (P<0.05). The incidence of cough, nausea, agitation and respiratory depression in the study group were significantly lower than those in the control group (P<0.05). Conclusion: Compared with ketamine combined with midazolam, dexmedetomidine combined with ketamine and midazolam had less impact on the cardiovascular system, higher safety, lower stress response and adverse reactions in patients with difficult airway intubation. It may have high application value in the anesthesia induction.