可弯曲喉罩用于鼻内镜手术患者气道管理的效果

目的 评价可弯曲喉罩用于鼻内镜手术患者气道管理的效果.方法 择期拟行鼻内镜手术患者60例,ASA Ⅰ或Ⅱ级,年龄18～60岁,体重51～83 kg,性别不限,随机分为2组(n=30):气管导管组(T组)和可弯曲喉罩组(F组).静脉注射咪达唑仑、维库溴铵、异丙酚和瑞芬太尼麻醉诱导.T组置入气管导管;F组置入可弯曲喉罩,然后行机械通气.静脉输注异丙酚和瑞芬太尼,吸入七氟烷维持麻醉.术中维持BIS 40～55,维持MAP基础值60%～70%,必要时静脉输注硝酸甘油1～3μg·kg~(-1)·min~(-1)和艾司洛尔20～30μg·kg~(-1)·min~(-1)行控制性降压.术毕待患者清醒后拔出气管导管或可弯曲喉罩.于麻醉诱导前、麻醉诱导后即刻、置人气管导管或喉罩后1、3、5 min和拔出气管导管或喉罩即刻记录SP、DP和HR;于置入气管导管或喉罩后5、30 min和拔出气管导管或喉罩前即刻记录P_(ET)CO_2、气道峰压、平均气道压和SpO_2;记录术中需要控制性降压情况、苏醒时间、患者清醒到拔出气管导管或喉罩前呛咳的发生情况和术后24 h内咽痛的发生情况.结果 与T组比较,F组置人喉罩后各时点和拔出喉罩即刻SP、DP和HR降低,置人喉罩后各时点和拔出喉罩前即刻气道峰压降低(P＜0.05),平均气道压、P_(ET)CO_2和SpO_2差异无统计学意义(P＞0.05),术中需控制性降压率降低,苏醒时间缩短,呛咳和咽痛发生率降低(P＜0.05).结论 可弯曲喉罩用于鼻内镜手术时,可降低对患者血液动力学的干扰,有助于麻醉恢复,且不良反应较少,其效果优于气管导管.

Efficacy of flexible laryngeal mask airway for airway management in patients undergoing endoscopic sinus surgery

Objective To evaluate the efficacy of flexible laryngeal mask airway(FLMA)for airway management in patients undergoing endoscopic sinus surgery.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-60 yr weighing 51-83 kg undergoing endoscopic sinus surgery were randomly divided into 2 groups(n = 30each): tracheal tube group(group T)and FLMA group.Anesthesia was induced with midazolam,propofol,remifentanil and vecuronium and maintained with propofol,remifentanil and sevoflurane.Tracheal tube or FLMA was inserted and the patients were mechanically ventilated.BIS was maintained at 40-55 and MAP at 60%-70% of the basaeline value during operation.Nitroglycerin(1-3 μg·kg~(-1)·min~(-1))and esmolol(20-30 μg·kg~(-1)·min~(-1))were infused if necessary.BP and HR were continuously monitored and recorded before induction of anesthesia,immediately after induction at 1,3 and 5 min after insertion of tracheal tube or FLMA and immediately after removal of the tracheal tube or FLMA.P_(ET) CO_2,SpO_2,peak and mean airway pressure(P_(peak),P_(mean))were monitored.The use of nitroglycerin and esmolol infusion,emergence time,the occurrence of coughing and pharyngodynia in 24 h after surgery were also recorded.Results The 2 groups were comparable with respect to age,body weight,sex ratio and operation time.Systolic BP was significantly decreased after insertion of FLMA but increased after tracheal intubation as compared with the baseline values.P_(peak) was significantly lower in group FLMA than in group T.The number of patients who needed nitroglycerin and esmolol infusion during operation was significantly smaller,the emergence time shorter and the incidence of coughing and panryngodynia after operation lower in group FLMA than in group T.Conclusion The FLMA is better than tracheal intubation for endoscopic sinus surgery in terms of hemodynamic changes,emergence from anesthesia and adverse effects.