食管引流型喉罩在颈椎骨折手术中的应用观察

目的 通过比较两组病人分别置入喉罩和气管内插管的成功率和血流动力学变化,凸显食管引流型喉罩(PLMA)在颈椎骨折手术麻醉中的优越性.方法 将60例ASAⅠ～Ⅲ级颈椎骨折需行手术治疗的病人随机分为两组:食管引流型喉罩组(A组)和盲插气管插管组(B组).分别按常规麻醉诱导后置入气管导管或食管引流型喉罩(下统称麻醉构件).记录两组患者诱导前、诱导后、置构件后1 min、3 min、拔出构件前及后5 min的SBP、DBP和HR值,还有置入构件所需的时间、成功率及并发症等.结果 成功置入构件后1 min和3 min的BP及拔出构件前后的BP、HR组间比较差异均有统计学意义(P＜0.05),B组高于A组;而插置构件所用的时间和低氧血症、呛咳、支气管痉挛及出血血肿等麻醉并发症B组亦明显高于A组.结论 麻醉采用PLMA是一种操作简单快捷、安全舒适、术后呼吸道并发症少的呼吸支持方法,对颈椎骨折等插管困难病人尤其适用.     

喉罩在全麻下腹腔镜阑尾切除术中的应用

目的比较喉罩和气管插管用于全麻腹腔镜阑尾切除术对患者的血流动力学、通气功能的影响。方法40例ASAⅠ-Ⅱ级在全麻下行腹腔镜阑尾切除术的患者,随机分为喉罩组（L组）和气管插管组（T组）。记录麻醉诱导前（A1）、诱导后（A2）、插管（罩）后1min（A3）、气腹后5min（A4）、拔管（罩）后1min（A5）等各时点的HR、SPO2、SBP、DBP、PETCO2、气道峰压（Ppeak）,并观察术后相关并发症。结果L组A3、A5时HR、SBP、DBP与T组间差异有统计学意义（P〈0．05）,T组A3、A5时HR、SBP、DBP与A2间比较差异有统计学意义（P〈0．05）。T组拔管时及术后的不良反应明显多于L组（P〈0．05）。结论全麻喉罩通气用于腹腔镜阑尾切除术优于气管插管。易于维持血流动力学稳定,应激反应轻微,全麻恢复平稳。     

第三代喉罩和气管导管用于妇科腹腔镜手术的临床观察

目的 比较第三代喉罩(PLMA)与气管导管在妇科腹腔镜手术中的应用价值.方法 择期行妇科腹腔镜手术的40例病人,ASA为Ⅰ～Ⅱ级,年龄25～55岁,体重46～62 kg,随机分为两组,每组20例;Ⅰ组用第三代喉罩(PLMA),Ⅱ组用气管导管(TT);全麻诱导,咪唑安定0.15 mg/kg,维库溴铵0.1 mg/kg,芬太尼3 μg/kg,在药物完全起效后行PLMA和IT置入;分别记录两组病人麻醉诱导前、PLMA(IT)置入前、置入后1 min,3 min,5 min时的MAP和HR的数值,术后PLMA(IT)拔除后0 min,5 min时的MAP和HR的数值,并对置入PLMA和IT的一次成功率进行比较.结果 两组病人在麻醉诱导前及喉罩置入前的MAP,HR值相比较无显著差异(P＞0.05),而在置入后的1 min,3 min,5 min和术后拔除PLMA组的MAP,HR显著低于IT组(P＜0.05).结论 对于妇科腹腔镜手术,与应用气管导管相比较,应用PLMA血流动力更稳定,因此使用更为安全.     

SLIPA喉罩和食管引流型喉罩在老年人腹腔镜胆囊切除手术中的应用

目的 比较(SLIPA)喉罩和食管引流型喉罩(PLMA)用于老年腹腔镜胆囊切除手术患者气道管理的效果. 方法 拟择期行腹腔镜手术患者120例,年龄60～75岁,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分为3组,每组40例:气管插管组,SLIPA组和PLMA组.麻醉诱导后置入气管导管或喉罩,行间歇正压通气.记录麻醉诱导前(T0)、管(罩)置入成功即刻(T1)、气腹后10min(Ta)、拔除时(T3)、拔除后10 min(T4)平均动脉压及心率.记录管(罩)置入情况、置入时间、测定气道密封压.记录拔除管(罩)时呛咳、返流、误吸及喉痉挛的发生情况;管(罩)拔除后粘血及胃胀气的发生情况;术后2d内咽痛的置入发生情况. 结果 气管插管组、SLIPA组、PLMA组1次置入成功率分别为92.5％、92.5％、95.0％(x2=0.268,P＞0.05),2次置入成功率均为100.0％.气管插管组在麻醉诱导后和SLIPA组、PLMA组比较,患者的血流动力学变化有明显差异(t=4.076,P＜0.05).SLAPA组喉罩置入时间较气管插管组和PLMA组短,喉罩置入容易(t=43.561,P＜0.05).PLMA组喉罩气道密封压较SLIPA组高,但差异无统计学意义(￡=0.363,P＞0.05).3组患者反流、误吸、喉痉挛和胃胀气的发生率差异无统计学意义(t=0.321,P＞0.05);SLIPA组和PLMA组呛咳和咽痛的发生率低于气管插管组(分别为x2=26.674,10.568,均P＜0.05). 结论 SLIPA和PLMA喉罩均可保证有效通气,不良反应少.SLAPA喉罩置入更简单,而PLMA喉罩气道密封效果较好,更适用于老年腹腔镜胆囊切除手术患者.     

腹腔镜胆囊切除术的气管插管全麻和喉罩通气道的应用比较

腹腔镜胆囊切除术与传统手术操作不同，代之以电视下使用电刀、电凝剥离、止血等操作。本文选择30例病人随机分组，观察对比气管插管和喉罩通气道在腹腔镜胆囊切除术中对血流动力学的影响，现报道如下。     

喉罩与气管插管在老年乳腺外科手术中的应用比较

喉罩置入全麻在国内外各种手术中应用较广泛，但在老年人乳腺癌手术中应用总结较少。本文旨在总结这项技术的优点，把它用于老年乳腺癌手术全麻中，在满足手术要求情况下，比气管插管全麻减少了麻醉的并发症。     

SLIPA喉罩在全麻老年高血压患者中的应用

目的 探讨SLIPA喉罩在全麻老年高血压患者中使用的安全性和有效性.方法 随机选择择期全麻老年高血压患者60例,ASAⅡ～Ⅲ级,年龄65 ～ 89岁,随机分为SLIPA喉罩组(S组)和气管插管组(E组),每组30例.记录两组患者麻醉诱导前(T0)、插入喉罩/气管导管前(T1)、插入喉罩/气管导管时(T2)、拔除喉罩/气管导管前(T3)和拔除喉罩/气管导管时(T4)的收缩压(SBP)、舒张压(DBP)及心率(HR);术中血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)和气道峰压(Ppeak);观察术中误吸、拔除喉罩/气管导管时躁动、呛咳和拔除喉罩/气管导管后喉痉挛、咽喉疼痛情况.结果 与E组比较,S组在T2 、T4时SBP、DBP、HR波动不明显(P＜0.05);拔除喉罩时躁动、呛咳的发生率及拔除喉罩后咽喉疼痛发生率明显减少(P＜0.05).两组术中SpO2、PETCO2和Peak均在正常范围内,无显著性差异(P＞0.05),均无误吸发生.结论 SLIPA喉罩在老年高血压患者全麻手术中,插入/拔除时对血流动力学无明显影响,术后不良反应少,优点明显大于气管插管,可安全有效地应用于老年高血压患者.     

Proseal喉罩在妇科腹腔镜手术中的应用

妇科腹腔镜择期手术患者60例,ASAⅠ-Ⅱ级,随机分为喉罩组和气管导管组。TCI血浆靶控输注得普利麻PFS和瑞芬太尼,术中调整靶浓度把BIS值维持在50±5范围内。记录心率（HR）、平均动脉压（MAP）、气道峰值压（Pmax）、气道平均压（Pmean）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）的数值。发现两组间各时间点HR、MAP、Pmax、Pmean、PETCO2变化无统计学差异,两组SPO2一直保持稳定水平;两组一、二次置管（罩）和置管（罩）总的成功率基本相同;两组麻醉时间、手术时间无显著性差异,喉罩组麻醉药用量明显小于气管导管组。拔管（罩）期并发症喉罩组明显低于气管导管组。提示Proseal喉罩用于妇科腹腔镜手术安全可靠。     

双管喉罩全麻复合连硬阻滞在老年腹腔镜胆囊切除术中的应用

腹腔镜胆囊切除术具有创伤少、手术时间短、术后痛苦轻、恢复快等优点,同时因腹腔内注入二氧化碳气体,具有腹内压较高的特点,因此手术过程中要求麻醉深度适中,如合适的麻醉和肌肉松弛,控制膈肌抽动,保证呼吸和循环平稳[1].我院采用双管喉罩全麻复合连硬阻滞应用于腹腔镜胆囊切除术,取得了良好效果.     

喉罩全麻胸腔镜治疗原发自发性气胸的临床应用

目的评价喉罩全麻在胸腔镜手术治疗原发自发性气胸中的可行性与安全性。方法选取40例行胸腔镜手术治疗原发自发性气胸患者的临床资料。其中20例采用喉罩全麻(喉罩组),20例采用双腔气管插管全麻(气管插管组)。比较、分析两组术中、术后相关指标。结果所有患者均顺利完成手术,无中转开胸和死亡病例。两组术中指标:手术时间、术中出血量、术中最低SpO_2、术中最高PetCO_2比较差异无统计学意义(P 0. 05);术后指标:术后胃肠道反应、术后咽喉疼痛、术后声嘶、术后引流时间、术后住院时间比较差异有统计学意义(P 0. 05),麻醉苏醒时间、术后进食时间、术后下地时间比较有显著差异(P 0. 001);麻醉费用及住院总费用两组间有显著差异(P 0. 001),手术费用两组差异无统计学意义(P 0. 05)。结论喉罩全麻胸腔镜治疗原发自发性气胸安全可行,麻醉时间短,气道损伤小,术后恢复快,值得临床推广。     

小剂量芬太尼和舒芬太尼对全麻诱导喉罩置入时心血管反应的影响

目的比较运用小剂量芬太尼和舒芬太尼时全麻诱导患者喉罩置入时的心血管反应。方法择期行下腹部或下肢手术的患者40例,随机分为芬太尼组（F组）和舒芬太尼组（S组）。麻醉诱导分别采用静脉注射异丙酚2mg／kg,罗库溴铵0．6mg／kg,F组给予芬太尼2μg/kg,S组给予舒芬太尼0．25μg/kg,诱导完成后置入喉罩。分别记录麻醉前（T0）、诱导完毕（T1）、喉罩置入即刻（1、2）、喉罩置入后1min（T3）、2min（T4）、3min（T5）、4min（T6）和5min（T7）时患者的血压和心率,并观察有无相关的不良反应及并发症。结果从麻醉诱导后到置入喉罩后5min,两组患者心率变化差异无统计学意义（P〉0．05）。与T0相比,F组在T1、T2和T3时间点心率下降,差异有统计学意义（P〈0．05）;S组在T1和T2时间点心率下降,差异有统计学意义（P〈0．05）。两组心动过缓的发生率差异无统计学意义。从麻醉诱导前到喉罩置入后5min,两组间各时间段收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）的变化差异无统计学意义（P〉0．05）。与110比较,两组患者在观察期的不同时间点出现SAP、DAP、MAP下降,差异有统计学意义（P〈0．05）。结论小剂量芬太尼和舒芬太尼进行全麻诱导喉罩置入时,两者均有效抑制了喉罩置入时的心血管反应,为喉罩置入提供了良好条件。     

ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

目的 比较ProSeal喉罩和气管导管在全身麻醉(全麻)苏醒期对老年乳腺癌根治术患者的影响.方法 美国麻醉医师学会(ASA)分级Ⅰ-Ⅱ级、择期在全麻下行乳腺癌根治术的老年女性患者30例,随机分为2组,ProSeal喉罩组(喉罩组,15例)与气管导管组(导管组,15例).全麻后喉罩组放置ProSeal喉罩,导管组为气管插管.记录两组患者入室后5min(T0)、手术结束(T1)、呼唤睁眼(T2)、拔除导管或喉罩后即刻(T3)、拔除导管或喉罩后3min(T4)时的心率、收缩压、舒张压;记录全麻苏醒期使用降压药的例数,呛咳、烦躁及拔除导管或喉罩后咽痛、恶心、呕吐发生率.结果 喉罩组在T2点血压、心率[(140.2±8.7)mm Hg、(77.1±7.4)次/min]仅轻度增高,与T0[(134.8±12.6)mm Hg、(71.5±8.8)次/min]比较差异无统计学意义(P＞0.05);但在T3点血压、心率[(143.3±8.5)mm Hg、(81.7±6.8)次/min]升高与T0比较差异有统计学意义(P＜0.05).导管组在T2和T3时点,血压、心率[(146.5±13.5)mm Hg、(85.7±6.6)次/min和(151.4±11.7)mm Hg、(95.3±6.8)次/min]较T0[(132.1±12.1)mm Hg、(70.3±8.0)次/min]均明显增加(P＜0.05),在T3点达最高峰.在T2、T3时点,喉罩组的血压、心率增加程度明显小于导管组(P＜0.05).喉罩组患者苏醒时使用降压药、呛咳、咽痛的例数明显少于导管组(P＜0.05);而拔管后烦躁、恶心、呕吐等并发症发生率,两组差异无统计学意义(P＞0.05).结论 老年乳腺癌根治术患者使用ProSeal喉罩,明显减少麻醉苏醒期并发症的发生,有利于老年患者的麻醉安全.     

ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.     

ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association (ASA)Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups: ProSeal laryngeal mask airway group(PLMA group, n=15) and endotracheal tube group (ET group, n=15). The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate (HR), systolic blood pressure(SBP)and diastolic blood pressure (DBP) were recorded at the time points of 5 min after entering operation room (T0), end of surgery (T1), opening eyes (T2), after extubation (PLMA) immediately (T3) and 3 min after extubation (PLMA) (T4). The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure (BP) and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0(P＞0.05). But the BP and HR were significantly higher at T3 than at T0 (P＜0.05). In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 (P＜0.05), and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 (P＜0.05). The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group(P＜0.05). No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed(P＞0.05). Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.     

全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术中的应用

目的 探讨全身麻醉联合硬膜外麻醉在老年高血压患者腹腔镜胆囊切除术（LC）中的麻醉效果。方法 将择期行LC的老年高血压患者64例分为对照组32例和观察组32例,分别采用全身麻醉和全身麻醉联合硬膜外麻醉,比较两组患者术中血流动力学情况[收缩压（SBP）、舒张压（DBP）、心率（HR）］、激素[生长激素（GH）、催乳素（PRL）和皮质醇（Cor）］水平及术后麻醉恢复情况。结果 在T1、T2 和T3 时,观察组SBP和DBP均显著低于对照组（P<0.05）,HR显著快于对照组（P<0.05）;观察组GH分别为（11.44±2.27） mg/L、（8.03±2.56） mg/L和（9.34±2.82） mg/L,显著低于对照组的[（13.25±3.56） mg/L、（9.51±3.14） mg/L和（10.92±3.25） mg/L,P<0.05或P<0.01];PRL分别为（70.76±5.55） mg/L、（60.43±7.85） mg/L和（64.36±7.59） mg/L,显著低于对照组的[（81.32±4.03） mg/L、（73.01±8.04） mg/L和（76.39±6.65） mg/L,P<0.05或P<0.01]; Cor分别为（480.33±26.16） mg/L、（469.27±28.76） mg/L和（477.91±21.78） mg/L,显著低于对照组的[（511.45±27.69） mg/L、（484.21±23.13） mg/L和（495.40±26.67） mg/L,P<0.05或P<0.01];观察组患者术后呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间分别为（7.81±3.12） min、（8.25±3.23） min、（16.73±4.28） min和（19.55±5.23） min,均显著短于对照组的[（10.20±3.87） min、（10.21±3.84） min、（21.45±4.50） min和（23.29±5.41） min,P<0.05或P<0.01];对照组苏醒期8例（25.0%）发生烦躁,明显高于观察组2例（6.3%,P<0.05）。结论 全身麻醉联合硬膜外麻醉用于老年高血压患者行LC 时血流动力学指标更稳定,激素应激反应更轻,麻醉恢复快。     

Meta-analysis and trial sequential analysis of randomized evidence comparing general anesthesia vs regional anesthesia for laparoscopic cholecystectomy

BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy, the outcomes of such procedure under regional anesthesia(RA) have been evaluated. In the context of cholecystectomy, combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA) in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included. The study populations in the RA and GA groups were of comparable age(P = 0.41),gender(P = 0.98) and body mass index(P = 0.24). The conversion rate from RA to GA was 2.3%. RA was associated with significantly less postoperative pain at 4 h [mean difference(MD):-2.22, P 0.00001], 8 h(MD:-1.53, P = 0.0006), 12 h(MD:-2.08, P 0.00001), and 24 h(MD:-0.90, P 0.00001) compared to GA. Moreover, it was associated with significantly lower rate of nausea and vomiting [risk ratio(RR): 0.40, P 0.0001]. However, RA significantly increased postoperative headaches(RR: 4.69, P = 0.03), and urinary retention(RR: 2.73, P = 0.03). The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes, with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA. However, its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.     

喉罩全麻在老年动脉瘤介入栓塞术中的应用

目的 探讨喉罩全麻在老年颅内动脉瘤介入栓塞术中的临床应用.方法 以2018年1月至2020年1月的60例择期全麻下行颅内动脉瘤介入栓塞术的老年患者为研究对象,60例患者随机分为两组.麻醉诱导后,分别置入喉罩或插管进行机械通气,两组给予同样的麻醉方法,诱导后均泵注3μg/(kg·h)瑞芬太尼、3～5mg/(kg·h)丙泊...     

经喉罩实施全身麻醉下支气管介入治疗的应用及价值

与气管插管相比,喉罩置入简单、快捷,对血流动力学影响小,适用的气道病变更加广泛,可以用于包括声门下在内的几乎所有的气管或支气管病变;与硬镜的开放性通气相比,喉罩的密闭通气,通气效果更加确切,经济成本低,符合中国的国情,可以在临床上推广。     

插管导入器在老年腹腔镜胆囊切除术患者全身麻醉气管插管中的应用效果观察

目的观察插管导入器在老年腹腔镜胆囊切除术患者全身麻醉气管插管中的应用效果。方法选择60例择期腹腔镜胆囊切除术(LC)老年患者,随机分为插管导入器组(A组)和直接喉镜组(B组)。A组采用插管导入器辅助气管插管,B组直接喉镜下直视气管插管。记录并比较患者麻醉诱导前(T0)、麻醉诱导后气管插管前(T1)、插管即刻(T2)、气管插管后1 min(T3)、气管插管后5 min(T4)各个时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2),以及两组的插管时间和成功率,观察插管后有无咽喉口腔黏膜损伤、牙齿牙龈损伤、咽喉疼痛以及声音嘶哑等并发症发生。结果两组在T2、T3时间点的MAP、HR均明显高于插管前(P0.05);且B组较A组明显升高(P0.05);A组插管时间和并发症发生率明显短于或低于B组(P0.05)。结论插管导入器辅助气管插管比直接喉镜更能有效地抑制老年患者气管插管的应激反应,维持血流动力学的稳定,对提高老年患者全麻诱导和气管插管期间的安全性和舒适度有重要临床意义。