摘要
目的 比较普通气管导管、声门上下注药型气管导管和喉罩用于全麻腹腔镜胆囊手术时,气管插管及拔管前后患者血流动力学、呼吸力学及术后咽部并发症的情况。方法 60例ASAⅠ-Ⅱ级全麻腹腔镜胆囊切除术患者,随机分为普通气管导管组（A组）、声门上下注药型气管导管组（B组）和喉罩组（C组）。分别记录3组麻醉诱导前基础值（T0）,喉罩/气管导管插入前（T1）,插入后即刻（T2）、3 min（T3）、5 min（T4）、10 min（T5）,喉罩/气管导管拔除前（T6）,拔除后即刻（T7）、3 min（T8）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）,记录T2-T6时的平均气道压（Pmean）、气道峰压（Ppeak）和呼气末二氧化碳分压（PETCO2）,记录拔管时间（从停药至拔除气管导管或喉罩的时间）,插入和拔除过程中喉痉挛、反流误吸等情况,及拔管前Riker镇静和躁动评分（SAS）、24 h后声嘶咽痛的发生率及声嘶咽痛视觉模拟评分（VAS）、术后有无肺部感染等。结果 T2时的SBP、DBP、HR,C组显著低于A组与B组;T3、T4、T6-T8时A组显著高于B、C组。A、B两组在T2时的Pmean、Ppeak明显高于C组（P〈0.05）,A组T3、T6时的Pmean、Ppeak明显高于B组和C组（P〈0.05）,PETCO2、SpO23组间差异无统计学意义;拔管时间3组间差异无统计学意义;拔管前躁动评分（SAS）,24 h后声嘶咽痛的发生率及声嘶咽痛视觉模拟评分（VAS）A组显著高于B组和C组。3组患者插入和拔除过程中均无喉痉挛、反流误吸等情况发生。3组患者均无术后肺部感染发生。结论 声门上下注药型气管导管和喉罩用于全麻气管插管及拔管前后可以很好地维持血流动力学的稳定,通气可靠有效,术后咽喉部并发症少,效果优于普通气管导管。
Objective To observe the effects of endotreacheal intubation, endotracheal intubation with inject-ing medicine and laryngeal mask airway on hemodynamics, respiratory mechanics and the complications of throax after op-eration in patients undergoing laparoscopic cholecystectomy. Methods Sixty ASA I-Ⅱ general anesthesia patients sched-uled for selective laparoscopic cholecystectomy were randomized into three groups （n=20）： the endotreacheal intubation group, endotracheal intubation with injecting medicine group, and laryngeal mask airway group. SBP, DBP, HR and SpO 2 were recorded at 9 time points： the basic value before anesthesia induction （T0）, before intubation（T1）, the moment of intu-bation（T2）, 3 min（T3）, 5 min（T4）, 10 min（T5） after intubation, before extubation（T6）, the moment at extubation（T7）, 3 min（T8） after extubation. Pmean, Ppeak and PETCO2 were measured at T2-T6 under the tidal volume in 8 ml/kg respectively. The time of extubation, laryngeal spasm, reflux and aspiration before extubation, agitation score, the incidence and visual analog scale （VAS） of sore throat and hoarseness at 24 h of post-operation. Results In group C, SBP, DBP and HR were significant-ly lower than those in group A and B at T2 （P〈 0.05）. The SBP, DBP and HR in group A was significantly higher than those in group B and C at T3、T4、T6-T8 （P〈0.05）. Pmean and Ppeak were higher in group A and B than those in group C at T2 （P〈0.05）. Pmean and Ppeak in group A was significantly higher than those in group B and C at T3 and T6 （P〈0.05）. In group A, the agitation score, sore throat and visual analog scale （VAS） were significantly higher than those in group B and C. Conclusion Anesthesia endotracheal intubation with injecting medicine between endotracheal and laryngopharynx can maintain the stability of hemodynamics during general anesthesia, and have fewer throat complications after operation. The Efficacy is better than that of general endotracheal intubation
出处
《北京医学》
CAS
2014年第8期646-649,共4页
Beijing Medical Journal
关键词
腹腔镜胆囊切除术
全身麻醉
喉罩
血流动力学
声门上下注药型气管导管
Laparoscopic cholecystectomy
General anesthesia
Laryngeal mask
Hemodynamics
Endotra-cheal intubation with injecting medicine
