摘要
目的观察I-gel喉罩联合气管导管应用于后颅凹手术预防插管与拔管反应的效果。方法择期行后颅凹手术患者60例,年龄20～60岁,体重35～90kg,ASA分级Ⅰ～Ⅱ级,采用随机数字表法将其分为2组(n=30):气管导管组(TT组)和I-gel喉罩联合气管导管组(TI组)。麻醉诱导后,分别置入气管导管(TT组)或I-gel喉罩联合气管导管(TI组)行机械通气。于患者入室后10min(T0)、麻醉诱导前即刻(T1)、气管导管置入即刻(T2)、置入后3min(T3)、拔除喉罩(TI组)或气管导管(TT组)前即刻(T7)、拔除后1min、5min和15min(T8-10)时记录MAP、HR;TI组于拔除气管导管前即刻、拔管即刻及拔出后3min(T4-6)时记录MAP、HR、Ppeak、PETCO2;记录手术时间、麻醉恢复时间、MOAA/S评分、恢复期并发症发生情况和血管活性药使用情况。结果与T0时比较,TT组MAP于T1-3时降低,T7-8时升高(P<0.05),HR于T1-3,7,9-10时降低,T8时升高(P<0.05);TI组MAP于T1-3,7,9-10时降低(P<0.05),HR于T1-3,7.8-10时降低(P<0.05)。与TT组比较,TI组虽拔管时间有所延长,但拔喉罩时MOAA/S评分明显增高(P<0.05),同时拔喉罩时呛咳、血压升高、心动过速和血管活性药物使用的例数显著减少,T2-3,7-10时MAP、HR降低(P<0.05)。与T4时比较,T5时HR升高(P<0.05)、T5-6时Ppeak、PETCO2升高但无统计学意义(P>0.05),且指标均在正常范围。结论后颅凹手术中,I-gel喉罩与气管导管联合应用既能保证患者的通气,又可减轻患者插管与拔管的反应,提高麻醉苏醒质量,降低不良事件的发生几率。
Objective To observe the effect of I-gel laryngeal mask combined with endotracheal tube to prevent the response of intubation and extubation in patients with posterior fossa surgery.Methods 60patients undergoing posterior fossa surgery,aged 20to 60years old,weighing 35～90kg,ASA classⅠorⅡ,were randomly divided into two groups（n=45）： The endotracheal tube group（TT group） and I-gel laryngeal mask joint endotracheal tube group（TI group）.The endotracheal tube group（TT group） and I-gel laryngeal mask joint endotracheal tube group（TI group） were inserted after induction of anesthesia and then the patients were ventilated.MAP and HR were monitored during anesthesia and the monitoring points were as follows ： 10min after entering the operating room（To）、 immediately before induction of anesthesia（T 1）、 endotracheal tube placement immediately（T 2）、 3min after implantation（T 3）、 immediately before removing laryngeal mask（TI group） or endotracheal tube（TT group）（T 7）、 1min 、 5min and 15min after removing（T 8-10）;MAP 、 HR 、 Ppeak 、 PETCO 2 were recorded at following time points,immediately before extubation（T 4） immediately extubation（T 5）,3min after extubation（T 6） in group TI.Operation time,anesthesia recovery time,MOAA / S score,occurrence of the complications of convalescence,usage of vasoactive drugs were recorded.Results Compared with To,MAP was decreased at T 1-3 and increased at T 7-8（P0.05）,HR was decreased at T 1-3,7,9-10 and increased at T8（P0.05） in group TT;MAP was decreased at T 1-3,7,9-10,HR was decreased at T 1-3,7.8-10（P0.05） in group TI.Compared with group TT,the extubation time was longer but the MOAA / S score when you pull the I-gel laryngeal mask was significantly higher（P0.05）,choking when pulling I-gel laryngeal mask,elevated blood pressure,tachycardia,and usage of vasoactive drugs were significantly reduced in group TI,MAP and HR were decreased at T 2-3,7-10（P0.05）.Compared with T 4,HR was in
出处
《立体定向和功能性神经外科杂志》
2013年第3期137-141,共5页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
安徽省自然科学基金项目(编号:11040606M169)
关键词
I-gel喉罩
气管导管
插管反应
拔管反应
后颅凹手术
I-gel laryngeal mask
Endotracheal tube
Intubation reaction
Extubation reaction
Posterior fossa surgery
