鼻咽通气道复合面罩通气与喉罩通气在短小日间手术中的应用比较

目的 比较鼻咽通气道复合面罩通气与喉罩通气下静吸复合全麻在短小日间手术中的应用效果.方法 选择估计1h内的日间手术患者90例,随机均分为鼻咽通气道复合面罩组(面罩组)和喉罩组.记录诱导前(T0)、插入鼻咽通气道或喉罩前1 min(T1)、插入鼻咽通气道或喉罩即刻(T2)、切皮时(T3)、拔出鼻咽通气道或喉罩前1 min(T4)、拔出鼻咽通气道或喉罩即刻(T5) MAP、HR、PET CO2、SpO2、RR和VT；记录插入喉罩或鼻咽通气道的时间和一次成功率；记录清醒时间和离院时间,从麻醉开始至拔出鼻咽通气道或喉罩时出现体动、呼吸道梗阻、反流误吸以及术后出现咽痛、吞咽困难和声音嘶哑的患者例数.结果 两组患者诱导后均能较好的保留自主呼吸,维持稳定的RR、VT和PETCO2,T2、T5时喉罩组MAP明显高于、HR明显快于面罩组(P＜0.05),插入鼻咽通气道时间明显短于插入喉罩的时间(P＜0.05),一次性插入鼻咽通气道的成功率高于一次性插入喉罩的成功率(P＜0.05),术中和术后不良反应喉罩组高于面罩组(P＜0.05).结论 鼻咽通气道复合面罩通气下静吸复合全麻用于短小日间手术能够维持循环和呼吸的稳定,苏醒迅速,在日间手术中是一种安全有效的麻醉方法.

Comparison of mask combined nasopharyngeal ventilation with laryngeal mask ventilation in patients undergoing day surgery

Objective To investigate the efficacy of mask combined nasopharyngeal ventilation or laryngeal mask ventilation in patients undergoing day surgery under combinded inhalation and intravenous anesthesia.Methods Ninety patients in day surgery about 1 h were enrolled and randomly divide into two groups:mask combined nasopharyngeal group and laryngeal mask group.The following were recorded:MAP,HR,PETCO2,SpO2,RR,VT at different time,the time and once success rate to insert laryngeal mask or nasopharyngeal airway,the time when all patients sober up and leave hospital,the numbers of patients that have body movement,airway obstruction,regurgitation or aspiration,sore throat,dysphagia,hoarseness after surgery.Results Patients in both groups keep spontaneous breathing well,maintained stable RR,VT and PETCO2.Circulatory status in group mask combined nasopharyngeal is more stable than group laryngeal mask.MAP and HR at T2 or T5 in group laryngeal mask is obviously higher than in group mask (P<0.05),in addition the time to insert nasopharyngeal airway is obviously shorter than group laryngeal mask (P<0.05).Success rate to insert nasopharyngeal airway is also higher than group laryngeal mask.Adverse effects in group laryngeal mask are also obviously higher than in group mask combined nasopharyngeal (P<0.05).The duration that patients in both groups sober up or leave hospital don’t have obvious difference.Conclusion Combinded inhalative and intravenous anesthesia under mask combined nasopharyngeal ventilation can maintain respiratory and circulatory in day surgery,soberness is quicker,which is a safe and effective anesthetic method in day surgery.