Supreme喉罩复合右美托咪定用于脑动脉瘤弹簧圈栓塞术的麻醉

The Anesthetic Use of Supreme Laryngeal Mask Airway with Dexmedetomidine in the Coiled Embolization of Intracranial Aneurysms

摘要: 目的：研究supreme喉罩复合右美托咪定用于脑动脉瘤弹簧圈栓塞术麻醉的临床价值。方法：择期行脑动脉瘤弹簧圈栓塞术患者200例随机分为两组：喉罩复合右美托咪定全麻组(S组)和常规气管插管全麻(D组)。比较两组患者建立气道的时间；比较T₀ (基础生命值)；T₁ (建立气道前)，T₂ (建立气道后)，T₃ (动脉瘤栓塞即刻)，T₄ (拔出气管导管即刻)：收缩压(SBP)、舒张压(DBP)、心率(HR)的变化；比较术中麻醉药物的用量；比较苏醒期自主呼吸回复和拔管的时间和相关并发症诸如呛咳，咽痛发生的情况。结果：1) S组在建立气道的时间上快于D组(P < 0.05)；2) 围术期中S组的血压更平稳，组内比较无显著性差异(P > 0.05)，而D组血压波动大，尤其是在建立气道和拔出导管后，与诱导前有显著性差异(P < 0.01)；3) 两组在麻醉用药的总量肌肉松弛药及其拮抗药的用量上S组与D组间有显著性差异(P < 0.05)；4) 术后苏醒时间，呛咳，躁动和术后并发症的发生率上S组明显少于D组，且有显著性差异(P < 0.05)。结论：supreme喉罩复合右美托咪定用于脑动脉瘤弹簧圈栓塞术的麻醉方法，不但简便易行，刺激小，循环平稳，术后并发症发生少，有临床推广的价值。

Abstract: Objective: To discuss the clinical application of supreme laryngeal mask airway with dexmedetomidine anesthesia in the embolization of intracranial aneurysms. Methods: Two hundred patients scheduled for interventional divided into 2 groups (n = 100 each): LMA with dexmedetomidine (S group) and endotracheal intubation group (D group). Comparing the time of establishing the airway, the systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) during perioperation, there are basic value (T₀), the before patients induced (T₁), immediation after intubation (T₂), immediation of embolic aneurysm (T₃), tube drawing immediate (T₄); comparing the total anesthetic dosages used, the time for return of spontaneous breathing, the extubation time and the occurrence of adverse effects such as coughing and pharyngodynia. Results: 1) The time of establishing the airway, S group is less than D group (P < 0.05). 2) S group has more stable perioperative hemodynamics. There is no significant difference compared in S group (P > 0.05). But perioperative hemodynamics varies a lot in D group. Especially at intubation and extubation, compared the T0, there is statistically significant difference (P < 0.01); 3) the consumption of anesthetic dosages, the dosages of vacuronium and neostigmine, there is significant difference between S group and D group (P < 0.05). 4) Emergence from anesthesia was faster and occurrence of pharyngodynia was fewer in group S than that in group D. There is significant difference (P < 0.05). Conclusion: The clinical anesthesia use of supreme LMA with dexmedetomidine in the embolization of intracranial aneurysms, in terms of easy placement, less irritation, better hemodynamic profile, faster emergence and less adverse effects, should be promoted.