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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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

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

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