摘要
目的对比肥胖患者经七氟醚或七氟醚联合丙泊酚诱导BlockBuster喉罩的置入情况、呼吸暂停的发生率及持续时间,探索肥胖患者保留自主呼吸下置入BlockBuster喉罩所需合适的麻醉诱导方式。方法60例肥胖患者,按SPSS软件生成的随机数字分为两组(每组30例):七氟醚组(S组)和七氟醚联合丙泊酚组(SP组)。SP组恒速输注丙泊酚1 mg/kg(按去脂体重计算),S组恒速输注等容积生理盐水,两组患者吸入5%七氟醚,待患者意识消失调整七氟醚浓度使SP组和S组呼气末七氟醚浓度分别达2.7%、3.0%,下颌松弛后尝试置入喉罩。记录两组患者喉罩置入情况、诱导期间呼吸相关参数[呼吸暂停发生率,呼吸暂停时间,麻醉诱导及喉罩置入过程中SpO2情况,诱导前1 min(T0)、诱导后1 min(T1)、置入喉罩前1 min(T2)及置入喉罩后1 min(T3)的呼吸频率、潮气量]及相关并发症发生情况。结果两组患者喉罩首次置入成功率、喉罩二次置入成功率、首次喉罩置入评分情况、呼吸暂停发生率、呼吸暂停时间差异无统计学意义(P>0.05);两组患者不同时点潮气量比较,差异无统计学意义(P>0.05)。与S组比较,SP组喉罩置入时间及麻醉诱导时间缩短(P<0.05)、T2时呼吸频率降低(P<0.05)。与T0比较,两组患者在T1、T2、T3时潮气量下降(P<0.05),S组呼吸频率在T2、T3时上升(P<0.05),SP组呼吸频率在T1时下降、T2时上升(P<0.05);与T2比较,两组患者T3时潮气量上升(P<0.05)。两组患者均未出现SpO2<90%及严重的心动过缓(心率<45次/min)和低血压[SBP<90 mmHg(1 mmHg=0.133 kPa)]。结论七氟醚或七氟醚联合丙泊酚诱导可在保留自主呼吸下成功置入BlockBuster喉罩,对肥胖患者是安全舒适的诱导方式;同单独七氟醚诱导相比,联合小剂量丙泊酚诱导能缩短喉罩置入及麻醉诱导时间,同时并未明显增加呼吸抑制的风险。
Objective This study compared the situation of insertion of BlockBuster device,the occurrence ratio and duration of apnea under the general anesthesia induction by sevoflurane‑propofol versus sevoflurane for obese patients undergoing bariatric surgery.Methods Sixty obese patients were randomly(by SPSS software to generate random numbers)assigned into two groups(n=30):sevoflurane(S)group and sevoflurane combined with propofol(SP)group.Propofol 1 mg/kg according to lean body weight was intravenously administered at a constant speed in the SP group,and normal saline was infused at a constant speed in the S group.Then,5%sevoflurane was continuously inhaled by patients in both groups until loss of consciousness.After loss of consciousness,the inspired concentration of sevoflurane was adjusted to end‑tidal concentration of 3.0%for the S group and 2.7%for the SP group,respectively.Tried inserting the BlockBuster device after jaw relaxation.The insertion condition of BlockBuster device,the respiratory parameters during anesthesia induction[the incidence and duration of apnea,pulse oxygen saturation(SpO2),respiratory rate and tidal volume at 1 min before anesthesia induction(T0),1 min after anesthesia induction(T1),1 min before device insertion(T2),and 1 min after device insertion(T3)]were recorded.Results There was no statistically significant difference between the two groups in the rates of successful insertion of BlockBuster device at the first and second attempt,the score of the first laryngeal mask insertion,the number of laryn‑geal mask insertions and the incidence and duration of apnea(P>0.05).There was also no statistically significant difference in tidal volumes between the two groups at different time points(P>0.05).Compared with the S group,the duration for the procedures of laryngeal mask insertion and anesthesia induction were short in the SP group.The respiratory rates decreased at T2 in the SP group(P<0.05).Compared with T0,the tidal volumes decreased at T1,T2,and T3(P<0.05),the respiratory rates inc
作者
王海霞
仇焕容
魏威
金沐
田鸣
薛富善
Wang Haixia;Qiu Huanrong;Wei Wei;Jin Mu;Tian Ming;Xue Fushan(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第6期558-562,共5页
International Journal of Anesthesiology and Resuscitation
关键词
肥胖
喉罩
丙泊酚
七氟醚
呼吸暂停
Obese
Laryngeal mask
Propofol
Sevoflurane
Apnea
