摘要
目的评价Supreme喉罩用于高血压病老年患者气道管理的效果。方法选择高血压病老年患者40例，年龄65～75岁，体重45～70kg，BMI〈35kg／m2，ASA分级Ⅱ或Ⅲ级，高血压病程〉1年，采用随机数字表法，将患者随机分为2组（n=20）：气管插管组（T组）与Supreme喉罩组（s组）。静脉注射芬太尼、丙泊酚、维库溴铵行麻醉诱导，下颌松弛后，S组置入Supreme喉罩，T组置人气管导管，行机械通气。七氟醚，丙泊酚和维库溴铵维持麻醉。于入手术室、置入喉罩／气管导管即刻、1、2、5min、切皮、拔除喉罩／气管导管即刻（T0-6）时记录SP、DP、HR、SpO2；于L0-4.6时采集右颈内静脉血样4ml，测定血浆肾上腺素（AE）、去甲肾上腺素（NE）和多巴胺（DA）浓度；记录插管反应和拔管反应的发生情况、置入时间、置入次数；置入喉罩／气管导管后测定肺顺应性、气道峰压、气道密封压、平台压；记录拔除后咽部不良反应的发生情况。结果与T组比较，S组SP、HR、插管反应、拔管反应和咽部不良反应的发生率、血浆NE、AE和DA的浓度降低，置入时间缩短（P〈0．05）。与L时比较，S组B时血浆NE浓度升高，T组L0-4.6时血浆NE浓度升高，L1-3时血浆AE和DA浓度升高（P〈0．05）。结论Supreme喉罩用于高血压病老年患者气道管理的效果优于气管插管，Supreme喉罩置入和拔除反应小，咽部不良反应少。
[Abstract] Objective To evaluate the efficacy Of laryngeal mask airway （LMA） Supreme in the elderly patients with hypertension. Methods Forty elderly patients with more than 1-year history of hypertension, aged 65-75 yr, weighing 45-70 kg, with body mass index 〈 35 kg/m2 , were randomized into 2 groups （ n = 20 each） ： intratracheal intubation group （group T） and LMA Supreme group （group S）. Anesthesia was induced with fenta- nyl, propofol and vecuronium. LMA Supreme was inserted in group S or intratracheal intubation was performed in group T for mechanical ventilation. Anesthesia was maintained with sevoflurane, propofol and vecuronium. The systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and pulse oxygen saturation （ SpO2 ） were recorded after entering the operating room （T0）, at 0, 1, 2 and 5 min after LMA insertion or intuba- tion （T~_4）, at skin incision （T5）, and immediately after removal of LMA or extubation （T6） ~ Venous blood sam- ples were taken at T0_4.6 for determination of plasma epinephrine （AE）, noradrenaline （NE） and dopamine （DA） concentrations. The insertion and removal responses, LMA insertion/intubation time and the number of inserting LMA/intubation were recorded. The lung compliance, airway peak pressure, airway sealing pressure and airway plateau pressure were detected after LMA insertion/intubation. The side effects occurred in the pharynx were recorded after removal of LMA or extubation. Results Compared with group T, the SBP, HR, insertion and re- moval responses, incidence of side effects and plasma AE, NE and DA concentrations were significantly decreased and LMA insertion/intubation time was significantly shortened in group S （ P 〈 0.05）. Compared with the baseline value at To, the concentration of plasma NE was significantly increased at T2 in group S, the concentration of plas- ma NE was significantly increased at T1-4.6 and the concentration of plasma AE and DA was significantly incr
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2012年第9期1043-1046,共4页
Chinese Journal of Anesthesiology
基金
上海市奉贤区科学技术发展基金项目（沪奉科090603）
关键词
喉面罩
插管法
气管内
高血压
老年
Laryngeal mask
Intratracheal intubation
Hypertension
Elderly
