摘要
目的探讨喉罩全身麻醉自主通气对乳腺癌根治术患者呼吸与循环功能的影响。方法40例美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级择期在全身麻醉下实施乳腺癌根治术的患者随机分为自主通气组(SV组)和间歇正压通气组(IPPV组),SV组在诱导期尽量保留自主呼吸,待下颌松弛后插入喉罩,适当辅助通气至自主呼吸恢复正常并维持至术毕;IPPV组予常规麻醉诱导及维持。记录麻醉期间麻醉诱导前(T0)、插入喉罩前(T1)、插入喉罩后5 min(T2)、插入喉罩后30 min(T3)、插入喉罩后60 min(T4)、拔除喉罩前(T5)、拔除喉罩后30 min(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、分钟通气量(VE)、呼气末二氧化碳分压(PETCO2)以及吸气末七氟烷浓度(CINSEV)、呼气末七氟烷浓度(CETSEV)。并行动脉血气分析检查。结果①两组患者均可获得满意的插管条件,但SV组的诱导时间显著长于IPPV组(P<0.01),且均有不同程度的呼吸抑制,其插入喉罩前的CETSEV显著高于IPPV组(P<0.01),两组间清醒时间和躁动发生率的差异均无统计学意义(P值均>0.05)。②两组间SBP、DBP、HR、SpO2的差异均无统计学意义(P值均>0.05),SV组T1、T2时间点的VE均显著低于T0时间点(P值均<0.05),T2时间点的PETCO2显著高于T0时间点(P<0.01);SV组T1、T2时间点的PETCO2显著高于IPPV组(P值分别<0.05、0.01)。③两组血气分析的各项指标均能维持正常,T6时间点的pH值显著低于T0时间点(P值分别<0.05、0.01);IPPV组T6时间点的动脉血二氧化碳分压(PaCO2)显著高于T0时间点(P<0.05)。结论喉罩麻醉自主通气应用于乳腺癌根治术,术中及术后血流动力及呼吸功能均能维持接近生理状态,可替代机械通气。
Objective To investigate the effects of laryngeal mask anesthesia （LMA） for general anesthesia on the respiration and hemodynamics functions in patients undergoing radical mastectory. Methods Forty patients of American SocJety of Anesthesiologists （ASA） status Ⅰ or Ⅱ , who were scheduled for elective radical mastectory under general anesthesia, were randomly allocated to either spontaneous ventilation group （SV group） or intermittent positive pressure ventilation group （IPPV group）. Spontaneous respiration was maintained in SV group; the laryngeal mask was intubated when the lower jaw was relaxed; mechanical ventilation was given till simultaneous respiration recovered. IPPV group received routine anesthesia induction and anesthesia maintenance. The systolic and diastolic blood pressure （SBP and DBP）, heart rate （HR）, pulse oxygen saturation （SpO2）, minute volume of ventialtion （VE）, end-expired CO2 tension （ PET CO2 ）, inspiratory concentration of sevoflurane （CIN, SEV） , and expiratory concentration of sevoflurane （CETSEV） were recorded at different time points. The blood samples were taken from each group for blood gas analysis. Results （1） Satisfactory intubation conditions were obtained in both groups. The time of induction was significantly longer （P〈0.01）and the CET SEV before intubation in SV group was significantly higher than those in the IPPV group（P〈 0.01）. Both groups had different degrees of respiration inhibition. The period of awareness and the incidence of agitation were similar between the two groups （both P〉O. 05）. （2） SBP, DBP, SpO2 and HR were similar between the two groups （all.P〉0.05）. The VE at T1, T2 was significantly lower than at To in SV group （both P〈O. 05） ; PETCO2 at T2 was significantly higher than at To （P〈0.01）. The PETCO2 at T1, T2 in SV group were significantly higher than those in IPPV group （P〈0.05 or 0.01 ）. （3） The blood gas analysis in each group had normal results in both
出处
《上海医学》
CAS
CSCD
北大核心
2009年第11期1007-1010,共4页
Shanghai Medical Journal
关键词
喉罩
自主通气
间歇正压通气
血流动力学
呼吸功能
血气
Laryngeal. mask airway~ Spontaneously ventilated
Intermittent positive pressure ventilated
Heamodynamic
Respiratory function
Arterial blood-gas analysis
