摘要
目的对比研究气管插管和喉罩通气在老年患者全膝关节置换术麻醉中的应用。方法选择2014年4月至2015年5月在新疆维吾尔自治区人民医院进行全膝关节置换术的老年患者60例，完全随机分为气管插管组（30例）和喉罩组（30例）。2组均采用丙泊酚1．5mg／kg、芬太尼3仙g／kg进行麻醉诱导，气管插管组加用维库溴铵0．1mg／kg，气管插管组置入气管导管，喉罩组置入喉罩；根据潮气末二氧化碳分压调整呼吸参数。2组维持麻醉用药为七氟烷2％～3％吸入联合丙泊酚静脉泵入，术中根据需要追加芬太尼和维库溴铵。比较2组置入管（罩）次数和术中及术后不良反应发生情况；比较2组患者全身麻醉诱导后插气管插管（喉罩）前（T0）、插管（罩）即刻（T1）、插管（罩）后1min（T2）、5min（T3）和术后在恢复室拔管（罩）（T4）时的心率、收缩压、脉搏血氧饱和度（SpO2）。比较2组手术结束至拔管（罩）时间及出恢复室时间。结果喉罩组置入失败1例，原因考虑患者扁桃体过大，改为气管插管，结果不纳入喉罩组。气管插管组与喉罩组一次置入成功率比较[96．7％（29／30）比90．0％（27／30）]，差异无统计学意义（P〉0．05）。气管插管组不良反应发生率明显高于喉罩组[63．3％（19／30）比24．1％（7／29）]，差异有统计学意义（P〈0．05）。T1、T2、T3、T4时点，气管插管组心率明显高于喉罩组[（89±17）次／min比（84±14）次／min、（76±10）次／min比（71±14）次／min、（74±9）[次／min比（70±10）次/min、（82±9）次／min比（77±13）次／min]，差异有统计学意义（P〈0．05）；T1、T2、T4时点，气管插管组收缩压明显高于喉罩组[（87±12）mmHg（1mmHg=0．133kPa）比（81±12）mmHg、（80±12）mmHg比（74±12）mmHg、（83±11）mmHg比（81±9）mmHg]，差异有统计学意义（P〈0．05）；2组
Objective To compare the the efficacy and safety of laryngeal mask airway and tracheal tube in total knee arthroplasty （TKA） in elderly patients. Methods Sixty elderly patients undergoing TKA from April 2014 to May 2015 were randomly divided into tracheal tube group （ETT group, 30 cases） and laryngeal mask airway group （LMA group, 30 cases）. ETT group and LMA group were induced with propofol 1.5 mg/kg and fentanyl 3 ~g/kg through endotracheal tube and laryngeal mask airway respectively, and ETI＂ group was additionally given vecuronium 0. 1 mg/kg; the respiratory parameters was adjusted according to the end-tidal carbon dioxide partial pressure; 2%-3% sevoflurane inhalation and intravenous infusion of propofol were given in maintenance of anesthesia, fentanyl and vecuronium were added according to need. The number of intubation or LMA insertion, intraoperative and postoperative adverse blood pressure （ SBP）, pulse oxygen saturation （ SpO2 ） reaction were recorded; the heart rate （HR）, systolic before intubation or LMA insertion （TO ）, immediately after intubation （ T1 ）, 1 and 5 min after intubation or LMA insertion （ T2, T3 ）, extubation （ T4 ） were compared between groups; the duration time from beginning of surgery to extubation, the time of leaving postanesthesia care unit （PACU） were compared between groups. Results One patient in LMA group LMA insertion was failed in 1 patients due to the large tonsils and turned into EET group, whose results were excluded from LMA group. The one time success rate of intubation or LMA insertion was not significantly different between EET group and LMA group [96.7% （29/30） vs 90.0% （27/30） ] （P 〉0.05）. The incidence of adverse reaction in LMA group was significantly lower than that in ETF group [24. 1% （7/29） vs 63.3% （19/30） ] （P 〈0.05）. The HR was significantly lower in LMA group than that in ETT group at T1, T2 , T3 , T4 [ （ 84 ± 14） times/min vs （ 89 ± 17） times/min, （71 ± 14） times/r
出处
《中国医药》
2016年第6期864-867,共4页
China Medicine
基金
新疆维吾尔自治区人民医院院内项目（20140104）
关键词
关节成形术
置换
膝
气管插管
喉罩
血流动力学
Arthroplasty, replacement, knee
Tracheal intubation
Laryngeal mask airway
Hemodynamics
