摘要
目的观察比较喉罩与气管插管对烧伤患者手术应激及全麻苏醒的影响。方法选择进行烧伤手术的成年烧伤患者(ASAⅠ～Ⅲ级)40例,随机分为喉罩组(A组)和气管插管组(B组)2组,每组20例。两组患者均使用舒芬太尼0.2μg/kg,咪唑安定0.06mg/kg,丙泊酚1.0-2.0mg/kg,顺式阿曲库铵0.2mg/kg进行诱导,待药物完全起效后,A组置入喉罩、B组气管插管。术中泵入丙泊酚3-8mg/(kg·h)及瑞芬太尼6-10μg/(kg·h)维持,并吸入1%-2%七氟烷,间断给予顺式阿曲库铵维持肌松,使患者术中BIS值维持在40-60。分别记录两组患者入室时(T_0)、诱导后插管前(T_1)、插管即刻(T_2)、插管后3min(T_3)、插管后5min(T_4)、拔除喉罩或气管导管前(T5)、拔除喉罩或气管导管即刻(T_6),各时间点的平均压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2),呼气末二氧化碳分压(PETCO2),气道峰压(Ppeak)及气道平台压(Pplat)的值。于上述T_0、T_1、T_2、T_3、T_4时点抽取静脉血,测定血糖(Glu)、血清皮质醇(Cor)浓度。术后统计并比较各组患者苏醒期包括苏醒延迟、喉痉挛、恶心呕吐及苏醒期躁动等并发症的发生情况。于拔管后5min(T7)、拔管后4h(T_8)及拔管后24h(T_9)对患者进行咽喉部的疼痛评分(VAS评分)。结果两组患者麻醉前及插管前各项指标差异无统计学意义(P>0.05)。而喉罩/气管导管置入后及拔除时B组HR、MAP、Ppeak、Pplat、Glu、Cor较术前均明显高于A组(P<0.05);术后VAS评分,B组仍然显著高于A组(P<0.05)。而所有时间点SpO_2、PETCO_2组间、组内均无明显差异(P>0.05)。结论喉罩对于烧伤患者刺激更小,引起的应激反应更轻,对血流动力学影响更小,同时也明显降低了术后咽喉部不适的症状,有利于维持术中生命体征平稳、保护患者气道及术后康复,临床上应用于烧伤患者更具优势。
Objective To observe the effects of laryngeal mask airway and endotracheal intubation anesthesia on recovery quality and stress reaction in burn patient.Methods 40 cases of adult burn patients(ASAⅠ-Ⅲlevel)were randomly divided into laryngeal mask group(A group)and tracheal intubation group(B group)2 group,20 cases in each group.Both groups were treated with sufentanil 0.2μg/kg,midazolam 0.06mg/kg,propofol 1.0-2.0mg/kg,and cisatracurium 0.2mg/kg induction,after the drug is fully effective,the A group is placed into the laryngeal mask and B group tracheal intubation.Intraoperative infusion of propofol 3-8mg/(kg·h)and remifentanil 6-10μg/(kg·h)maintained,and inhaled 1%-2%seven halothane,intermittent giving of cisatracurium to maintain muscle relaxation,the value of BIS in 40~60 in maintenance operation.The groups of patients were recorded mean arterial pressure(MAP),hiart rate(HR),pulse oxygen saturation(SpO2),partial pressure of carbon dioxide in endexpiratory gas(PETCO2),peak pressure(Ppeak),and plateau pressure(Pplat)at 7 time points:after entering the operating room(T0),before intubation(T1),intubation immediately(T2),3min(T3)after intubation,5min(T4)after laryngeal mask insertion or endotracheal intubation intubation,before extubation(T5),and extubation immediately(T6).The venous blood was extracted from the T0,T1,T2,T3 and T4,and the concentration of blood glucose(Glu)and serum cortisol(Cor)was measured.The postoperative complications such as wake delay,laryngeal spasm,nausea and vomiting and restlessness in the wake period of each group were compared.The pain score(VAS score)was performed on the patient 5min(T7),4h(T8)and 24h(T9)after extubation.Results There was no statistically significant difference in preoperative and intubation indexes between the two groups(P>0.05).While after the laryngeal mask/tracheal catheter was placed and removed,group B HR,MAP,Ppeak,Pplat,Glu and Cor were significantly higher than those in group A(P<0.05).Post operative VAS score,group B was still significantly higher than group A(P<0.05).However,there was no significant difference(P>0.05)between SpO2,PETCO2 and group in all time points.Conclusion The laryngeal mask is less stimulating for burn patients,the stress response is lighter,the hemodynamic effect is smaller,and the symptom of postoperative sore throat is reduced obviously,which is helpful to maintain the stable vital signs,protect the patients'airway and postoperative rehabilitation,and it is more advantageous to burn patients clinically.
作者
王文祥
张学康
戴寒英
张蔚
王静静
WANG Wenxiang;ZHANG Xuekang;DAI Hanying(Departmen of Anesthesiology,The first affiliated Hospital of Nanchang University,Nanchang,330006,China)
出处
《江西医药》
CAS
2018年第11期1228-1231,共4页
Jiangxi Medical Journal
基金
江西省教育厅科学技术研究项目
编号GJJ14008
关键词
喉罩
气管插管
烧伤患者
应激反应
苏醒
Laryngeal mask
Tracheal intubation
Burn patients
Recovery quality
Stress reaction
