目的 探讨右美托咪定联合七氟醚吸入诱导用于病态肥胖合并重度鼾症患者喉罩置入的可行性和安全性.方法 前瞻性选择2018年1～12月首都医科大学附属北京友谊医院拟行减重手术的病态肥胖合并重度鼾症的患者40例,10 min内静脉输注1μg/kg的右美托咪定后,以5％的七氟醚为初始吸入浓度,每隔2 min七氟醚浓度增加1％,设定氧流量6 L/min.待患者对托下颌无体动反应后,置入喉罩.观察喉罩置入成功率,喉罩置入条件,诱导前(T1)、喉罩置入前(T2)、喉罩置入后1 min(T3)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、潮气量(TV)和呼气末二氧化碳分压(ETCO2)并记录吸入麻醉过程中和术后与喉罩置入有关的并发症.结果 40例患者中,38例患者顺利完成吸入诱导并成功置入喉罩,2例患者因发生呼吸暂停退出本研究,喉罩置入成功率为95％(38/40).10例(26.3％)患者的喉罩置入条件为优秀,28例(73.7％)患者的喉罩置入条件为满意.T1时的MAP、TV显著高于T2和T3(P ＜0.05);T2和T3时的HR和RR显著高于T1,T3时的HR和RR显著高于T2(P ＜0.05);T1时的ETCO2显著高于T2,并且低于T3(P ＜0.05).8例患者发生呼吸暂停,6例患者在置入口咽通气道后恢复自主呼吸.结论 应用右美托咪定联合七氟醚吸入诱导可为保留自主呼吸的病态肥胖合并重度鼾症患者喉罩置入提供良好的条件.%Objective To explore the feasibility and safety of dexmetetomidine (DEX) combined with sevoflurane inhalation under lryngeal mask airway (LMA) insertion in breathing spontaneously morbidly obese patients complicated with severe obstructive sleep apenea (OSA).Methods In this prospective study, forty morbidly obese patients complicated with severe OSA were scheduled for bariatric surgery in this hospital during January to December, 2018 were enrolled. After a bolus dose of 1 μg/kg DEX was intravenously injected, and evoflurane was inhaled and the inhalational sevoflurane concentration increased by 1％ every two minutes. LMA was inserted after loss of motor response to jaw thrust. The successful rate of LMA insertion, and the condition of LMA insertion was recorded. The heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), tidal volume (TV) and end-tidal carbon dioxide prrtial pressure (ETCO2) at the time of before induction (T1), and LMA insertion (T2) and 1 min after LMA insertion (T3) were recorded. The adverse complications during sevoflurane inhalation and related to LMA insertion were also recorded. Results Among these 40 patients, LMA was successfully iserted in 38 patients with completed sevoflurane inhalational induction. 2 patients withdrew from this study due to apnea during inhalational induction. The successful rate of LMA insertion was 95％ (38/40). 10 patients (26％) had excellent LMA insertion conditions while 28 patients (74％) had satisfactory LMA insertion. The MAP and TV at T1 were significantly higher than those at T2 and T3, P ＜ 0. 05. The HR and RR at T2 and T3 were significantly higher than those at T1, and HR and RR at T3 were significant higher than those at T2, (P ＜ 0. 05). The ETCO2 at T1 was significantly higher than that at T2 but lower than that at T3, (P ＜ 0. 05). Eight patients developed apnea during inhalational induction, and six patients returned to spontaneously breathing after oropharyngeal airway insertion. Conclusion The application of DEX combined with sevoflurane inhalational induction can provide good LMA insertion conditions for breathing spontaneously morbidly obese patients complicated with severe OSA.
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