摘要
目的探讨在颅内外动脉狭窄支架成形术的麻醉中，应用一次性喉罩的可行性和安全性。方法选择颅内外动脉狭窄患者80例，随机分为喉罩通气组和气管插管组，每组40例。麻醉诱导后，喉罩通气组采用一次性喉罩，气管插管组采用气管插管，行气道管理。记录两组麻醉前，气管插管／置入喉罩前、即刻，置入后1、3、5、10min以及拔除气管插管／喉罩时的血压、心率、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）和气道内压力（Paw）。观察两组体动、呛咳、咽痛等麻醉并发症。结果①两组患者在麻醉诱导后收缩压、舒张压及心率均较麻醉前明显下降（P〈0．01）。②气管插管组插管即刻，置入后1、3min及拔管时的收缩压、舒张压和心率，均明显升高；与插管前及喉罩通气组比较，差异有统计学意义（P〈0．01，P〈0．05）。喉罩通气组从喉罩置入到拔除各时点收缩压、舒张压和心率基本维持稳定，与置入前比较，各时间点差异均无统计学意义（P〉0．05）。③SpO2、PETCO2和Paw值组内各时间点及两组间比较，差异无统计学意义。④喉罩通气组无体动、呛咳、咽痛等并发症；气管插管组组患者发生体动4例（P=0．040）、呛咳1例（P=0．314），咽痛10例（P=0．001）。结论在颅内外动脉狭窄支架成形术的麻醉中，使用一次性喉罩能在维持良好通气功能的同时，保持血压、心率稳定，降低手术风险。
Objective To investigate the feasibility and safety of the application of disposable laryngeal mask airway during anesthesia in stent-assisted angioplasty for extracranial and intracranial artery stenosis. Methods Eighty patients with extracranial and intracranial artery stenosis were randomly assigned to either a laryngeal mask airway group or an endotraeheal intubation group （n = 40 in each group） during anesthesia. After the induction of anesthesia, the laryngeal mask airway group used the disposable laryngeal mask airway, and the endotracheal intubation group used the endotracheal intubation for airway management. The blood pressure, heart rate, oxygen saturation （SpO2 ）, end-tidal carbon dioxide tension （PET- CO2 ） and airway pressure （Paw） in both groups were monitored and recorded at the following time points： Before the induction of anesthesia, before and immediately after inserting the endotracbeal insertion/laryngeal mask airway, and 1, 3 5 and 10 minutes after the intubation, as well as at the extubation of the endotracheal insertion and removal of laryngeal mask airway. Anesthesia complications, such as body movement, irritating cough, and pharyngodynia were observed in both groups. Results （1）After the induction of anesthesia, the systolic pressure, diastolic pressure, and heart rate in both groups were decreased significantly than those before the anesthesia （P 〈 0. 01 ）. （2）The systolic pressure, diastolic pressure, and heart rate were increased obviously immediately after the insertion, 1 and 3 minutes after the insertion, and at the time of the extubation in the endotracheal intubation group; As compared with before endotracheal intubation and the laryngeal mask airway group, there were significant differences （P 〈0. 01, P 〈0.05）. The systolic pressure, diastolic pressure, and heart rate almost maintained stable at all time points from the intubation to extubation in the laryngeal mask airway group. As compared with before intubation, there were no significant differences at all time points （ P 〉 0. 05 ）. （3）There were no significant differences of SpO2, PETCO2 and Paw at all time points between the two groups. （4）There were no body movement, irritating cough, and pharyngodynia in the laryngeal mask airway group during the procedure ; while 4 patients experienced body movement （P =0. 040）, 1 had irritating cough （P = 0. 314）, and 10 suffered pharyngodynia （ P = 0. 001 ） in the endotracheal intubation group. Conclusion Using the disposable laryngeal mask airway in stent-assisted angioplasty for extracranial and intracranial artery stenosis can keep the hemodynamics stable, maintaining good ventilation function and reduce the risks of operation.
出处
《中国脑血管病杂志》
CAS
2009年第4期194-197,202,共5页
Chinese Journal of Cerebrovascular Diseases
关键词
麻醉
血管成形术
支架
颈动脉狭窄
颅内动脉疾病
血流动力学
一次性喉罩
Anesthesia
Angioplasty
Stents
Crotid stenosis
Intracranial arterial disease
hemodynamics
Disposable laryngeal mask airway
