右美托咪定复合不同药物诱导对全身麻醉患者脑电双频指数及插管和拔管时应激反应的影响

摘要

目的 探讨右美托咪定分别复合丙泊酚、咪达唑仑对全身麻醉患者脑电双频指数(BIS)、插管和拔管时机体应激反应的影响.方法 选取长治医学院附属和济医院2016年1月至2018年3月收治的行全身麻醉的120例患者作为研究对象,采用随机数字表法将其分为A组和B组,每组60例.A组采用右美托咪定复合咪达唑仑进行全身麻醉,B组采用右美托咪定复合丙泊酚进行全身麻醉.观察比较不同时间点两组BIS及应激反应相关指标的变化情况.结果 A、B组插管后即刻(T3)平均动脉压(MAP)、心率(HR)均较之前显著下降,而拔管前(T4)、拔管后即刻(T5)则显著回升(P＜0.05);但两组间不同时间点MAP、HR比较,差异未见统计学意义(P＞0.05).插管前(T2)及T3时两组BIS均较麻醉前(T1)下降,而T4时两组BIS均有所回升,B组T4时BIS回升幅度大于A组(P＜0.05),T5时两组BIS比较差异未见统计学意义(P＞0.05).结论 咪达唑仑、丙泊酚分别复合右美托咪定均可达到理想的全身麻醉镇静镇痛作用,临床医生在实际工作中应结合患者实际情况、经济能力等综合判断后选择合适的给药方案,从而有利于保障全身麻醉的效果并维持良好的医患关系.%Objective To investigate the effect of induction of dexmedetomidine combined with propofol and midazolam on the bispectral index (BIS) and the stress response at intubation and extubation of patients with general anesthesia.Methods A total of 120 cases who experienced general anesthesia in Heji Hospital Affiliated to Changzhi Medical College from January 2016 to March 2018 were selected as the research objects.And they were divided into group A and group B by random number table method,with 60 cases in each group.Patients in group A were treated with dexmedetomidine combined with midazolam and patients in group B were treated with dexmedetomidine combined with propofol.The changes of BIS and stress related indexes in two groups were observed and compared at different time points.Results The mean arterial pressure (MAP) and heart rate (HR) immediately after intubation were significantly lower than before in group A and group B,but these indexes significantly increased before extubation (T4) and immediately after extubation (T5),P ＜ 0.05;however,there was no significant difference in MAP or HR between the two groups at different time points (P ＞ 0.05).Before intubation (T2) and at T3,BIS decreased significantly compared with that before anesthesia (T1),while at T4,BIS increased in both groups (P ＜ 0.05).At T4,BIS in group B increased more than that in group A (P ＜ 0.05).But at T5,there was no significant difference in BIS between the two groups (P ＞ 0.05).Conclusions The combinations of dexmedetomidine with midazolam and propofol both can achieve the ideal analgesic effect of general anesthesia.The clinician should choose the appropriate judgment based on the actual situation and economic ability of the patients,so as to protect the general anesthesia effect and maintain a good doctor-patient relationship.