右美托咪定结合Cookgas Air-Q插管型喉罩气管插管在颈椎损伤病人全麻气道管理中的应用及对术后认知功能的影响

doi:10.3969/j.issn.1006-6233.2020.10.029

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摘要 目的: 研究右美托咪定联合Cookgas Air-Q插管型喉罩气管插管在颈椎损伤病人全麻气道管理中的应用价值及对术后认知功能的影响。方法: 选取承德市中心医院于2018年10月至2019年12月期间收治的120例颈椎损伤患者,根据随机数字表法分为对照组(右美托咪定联合气管插管)和观察组(右美托咪定联合Cookgas Air-Q插管型喉罩气管插管),各60例。比较麻醉药物泵注前(T0)、注药后1min(T1)、插管即刻( T2)以及插管完成后1min(T3)时的Ramsay评分、心率、血压、认知功能、应激激素指标变化,以及比较不良反应发生情况。结果: 血流动力学指标(SpO₂、HR、MAP)于T1时较T0时明显降低,T2、T3呈增加趋势,且观察组的血流动力学指标变化幅度低于对照组(P<0.05)。Ramsay评分于T1时较T0时明显增加,随后T2、T3时刻明显降低,其中观察组患者于T2、T3时刻的Ramsay评分均明显高于对照组(P<0.05)。观察组1次插管成功率、插管耐受率明显高于对照组,艾司洛尔使用率、躁动率明显低于对照组(P<0.05)。血清肾上腺素、去甲肾上腺素水平于T2时较T0、T1时均明显增加,随后T3时明显降低,其中观察组于T2、T3时的肾上腺素、去甲肾上腺素水平明显低于对照组(P<0.05)。术后1d MMSE评分较术前1d明显降低,术后3d、5d明显增加,且观察组于术后1d、3d的MMSE评分显著高于对照组,术后认知障碍以及术后咽痛发生率明显低于对照组(P<0.05)。结论: 右美托咪定联合Cookgas Air-Q插管型喉罩气管插管在颈椎损伤病人全麻气道管理中可有效稳定患者生命体征和氧化应激状态,提高首次插管成功率和耐受性,改善认知功能和镇静状态。

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关键词 ：右美托咪定, 插管型喉罩, 颈椎损伤, 氧化应激, 认知功能

Abstract：Objective: To study the value of dexmetomidine combined with Cookgas Air-Q intubated laryngeal mask tracheal intubation in general anesthesia airway management in patients with cervical spine injury and its effect on postoperative cognitive function. Methods: 120 patients with cervical spine injury admitted in our hospital from October 2018 to December 2019 were divided into control group (dexmedetomidine combined with tracheal intubation) and observation group (dexmedetomidine combined with Cookgas Air-Q intubated laryngeal mask tracheal intubation) according to the random digital table method, each with 60 cases. The changes of Ramsay score, heart rate, blood pressure, cognitive function and stress hormone indexes before injecting narcotic drugs (T0), 1 min after injection(T1), immediately after intubation (T2) and 1 minute after intubation (T3) and the occurrence of adverse reactions were compared. Results: Hemodynamic indexes (SpO₂, HR, map) were significantly lower in T1 than in T0, and increased in T2 and T3, and the range of hemodynamic indexes in the observation group was lower than that in the control group (P<0.05). Ramsay score increased significantly at T1 than at T0, and then decreased significantly at T2 and T3. Ramsay score of patients in the observation group at T2, T3 was significantly higher than that in the control group (P<0.05). The success rate and tolerance rate of intubation once were significantly higher than those in the control group and the esmolol use rate and agitation rate were significantly lower than those in the control group(P<0.05). The levels of serum adrenal hormone and thyroidene were significantly higher at T2 than at t0 and T1, and then significantly lower at T3, the levels of adrenal hormone and thyroid hormone in the observation group were significantly lower than those in the control group (P<0.05). The score of 1 d MMSE after operation was significantly lower than that of 1 d before operation, and 3d, 5d after operation were significantly increased. The MMSE score of the observation group at 1d, 3d after operation was significantly higher than that of the control group, and the incidence of postoperative cognitive impairment and postoperative pharyngeal pain was significantly lower than that of the control group(P<0.05). Conclusion: Dexmedetomidine combined with cook gas air-Q laryngeal mask airway intubation can effectively stabilize the vital signs and oxidative stress state of patients with cervical spine injury, improve the success rate and tolerance of the first intubation, and improve cognitive function and sedation state.

Key words： Dexmedetomidine Intubated laryngeal mask Cervical spine injury Oxidative stress Cognitive function

基金资助:河北省承德市科学技术研究与发展计划项目,(编号:202002A013)

通讯作者: 孙艳斌

引用本文:

安海燕, 孙艳斌, 孙淑红, 王文玺, 张雪维. 右美托咪定结合Cookgas Air-Q插管型喉罩气管插管在颈椎损伤病人全麻气道管理中的应用及对术后认知功能的影响[J]. 河北医学, 2020, 26(10): 1706-1712.
AN Haiyan, SUN Yanbin, et al. Application of Dexmetomidine Combined with Cookgas Air-Q Intubated Laryngeal Mask Tracheal Intubation in General Anesthesia Airway Management in Patients with Cervical Spine Injury and Its Effect on Postoperative Cognitive Function. HeBei Med, 2020, 26(10): 1706-1712.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.10.029 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I10/1706

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