瑞芬太尼异丙酚复合喉罩麻醉在经尿道输尿管镜下EMS碎石术中的应用研究

目的观察瑞芬太尼-异丙酚复合喉罩麻醉用于泌尿外科经尿道输尿管镜下超声气压弹道碎石清石系统（EMS）碎石术中可行性和临床效果。方法 60例在全麻下实施经尿道输尿管镜下气压弹道联合超声碎石术的患者,ASAⅡ～Ⅲ级,年龄24～71岁,随机被分为Supreme双管喉罩组（LMA组,n=30）和气管插管组（TT组,n=30）。患者麻醉前、插入喉罩后即刻、拔出气管插管前即刻以及拔出气管插管后即刻的心率（HR）、呼吸系统变化、平均动脉压（MAP）、麻醉深度指数及两组拔管期的不良反应和术后并发症。结果气管插管组插管2 h（T2）、T3、T4时MAP和HR均显著高于喉罩组（P〈0.05）;喉罩组患者拔管前即刻（T3）VT、PAW、PCL分别与TT组患者组间存在显著性差异（P〈0.05）。喉罩组患者麻醉深度指数在T3、T4时与气管插管组间差异有显著性意义（P〈0.05）。在术后拔管期双管喉罩组发生术后咽痛、呛咳、体动、声音沙哑较气管插管组显著减低（P〈0.05）;套囊血迹事件的发生率两组间无显著性差异（P〉0.05）。结论瑞芬太尼-异丙酚复合喉罩麻醉用于泌尿外科经尿道输尿管镜下气压弹道联合超声碎石术对患者呼吸循环的影响较小,患者对喉罩插入的耐受性较好,可明显减少咽喉并发症,其效果优于气管插管,安全可靠,值得临床推广。

Investigation of remifentanil plus propofol general anesthesia with laryngeal mask airway in transurethral ureteroscopy pneumatic and ultrasonic lithotripsy

Objective To investigate the feasibility and efficacy of remifentanil plus propofol general anesthesia with laryngeal mask airway（LMA） in transurethral ureteroscope pneumatic and ultrasonic lithotripsy.Methods Sixty patients with ureteral calculi,ASA Ⅱ-Ⅲ,aged 24-71 years,who received surgery for transurethral ureteroscopy pneumatic and ultrasonic lithotripsy under general anesthesia were randomly divided into LMA group（n=30） and tracheal intubation（TT） group（n=30）.MAP,HR,respiration system change and cerebral state index were recorded before induction of anesthesia（T1）,immediately after intubation（T2）,before extubation（T3）,and immediately after extubation（T4）.Adverse reactions during extubation and postsurgical complications were observed.Results MAP and HR were significantly higher in TT group than in LMA group at T2,T3,and T4（P〈0.05）.There were significant differences between LMA group and TT group in VT,PAW,and PCL at T3（P〈0.05）.There was significant difference between LMA group and TT group in cerebral state index at T3 and T4（P〈0.05）.The incidences of body movement and coughing during extubation and postoperative sore throat and hoarse voice were higher in TT group than in LMA group（P〈0.05）.Conclusion LMA has better tolerance and lower side effect than endotreacheal intubation in patients with transurethral ureteroscopy pneumatic and ultrasonic lithotripsy.It is easier to maintain hemodynamic and respiration function stability.