“微创”插管技术在甲状旁腺切除术全身麻醉诱导阶段的应用

目的 观察“微创”插管技术在甲状旁腺切除术气管插管全身麻醉诱导阶段的应用效果. 方法 选取拟在全身麻醉下行甲状旁腺切除术的患者100例,ASA分级Ⅲ、Ⅳ级,按随机数字表法分为微创组(L组)和对照组(C组),每组50例.麻醉诱导均采用咪达唑仑、依托咪酯、舒芬太尼、顺式阿曲库铵.L组于诱导后2.5 min用可视喉镜暴露声门,借助一次性喉麻管向喉头周围及声门内喷射2％利多卡因3 ml,继续面罩加压给氧2 min后插入7.0号超滑镇痛气管导管;C组在诱导后4.5 min应用普通喉镜插入7.5号普通气管导管.麻醉维持均采用持续泵入瑞芬太尼、丙泊酚,间断静脉注射顺式阿曲库铵.记录麻醉诱导前(T0)、插管前(T1)、插管时(T2)、插管后1 min(T3)、插管后3 min(T4)时的SBP、DBP、HR、SpO2,并分别于T1和插管后10 min(T5)抽取静脉血检测促肾上腺皮质激素(adrenocortical hormone,ACTH)和皮质醇(corticosteroid,CORT)含量(因CORT有日分泌节律,参与试验手术均安排上午). 结果 围插管期C组SBP、DBP、HR较L组明显升高,差异有统计学意义(P＜0.05),C组血中ACTH和CORT含量均较L组明显增加,差异有统计学意义(P＜0.05). 结论 “微创”插管技术可有效减少甲状旁腺切除术气管插管时心血管反应的发生,减少血液中应激激素释放,增加麻醉安全性.

Application of minimally invasive intubation in parathyroidectomy during induction of general anesthesia

Objective To observe effects of minimally invasive intubation in parathyroidectomy during induction of general anesthesia.Methods One hundred patients with ASA category of Ⅲ or Ⅳ were enrolled for thyroid gland resection under general anesthesia.These cases were randomly divided into minimally invasive group(group L) and control(group C)(n=50).General anesthesia was induced by the combination of midazolam,etomidate,sufentanil and CIS-atracurium.Tracheal intubation was performed under the guidance of laryngoscopy.Two point five min after induction of general anesthesia,group L received 2％ lidocaine spray on glottis,and an ID 7 tracheal tube was inserted.But an ID 7.5 tracheal tube was inserted in the group C patients 4 min after the induction of general anesthesia.We continuously pumped remifentanil and propofol,and intermittently infused CIS-atracurium to maintain anesthesia in patients.SBP,DBP,HR,and SpO2 were monitored before anesthesia induction (T0),immediately after induction(T1),before intubation (T2),1 min after intubation (T3),3 min after intubation (T4),respectively.At T1 and 10 min after intubation (T5),we extracted vein blood to measure adrenocorticotropic hormone (ACTH) and cortisol corticosteroid (CORT) in serum.Results During the intubation period,SBP,DBP,HR of group C increased significantly more than those of group L (P＜0.05),and levels of serum ACTH and CORT in group L remained unchanged instead of increased in group C.Conclusions Minimally invasive catheterization technique can effectively reduce cardiovascular responses to tracheal intubation,and attenuate the release of stress hormones in patients receiving parathyroidectomy.These may improve the safety of the operation.