喉罩通气在成人中耳显微手术中的应用

目的评价喉罩通气在全身麻醉中耳显微手术中的安全性和有效性。方法 100例美国麻醉医师协会（ASA）Ⅰ-Ⅱ级择期行中耳显微手术的成年中耳炎患者,随机分为喉罩组（LMA组,n=50）和气管插管组（ETT组,n=50）。记录患者进入手术室至手术开始的时间,各时间点的心率和血压变化：麻醉前（T0）、插管/罩前即刻（T1）、插管/罩后即刻（T2）、拔管/罩前即刻（T3）、拔管/罩后即刻（T4）。记录2组患者插管/罩时体动或呛咳和拔管/罩时的呛咳反应。记录手术结束至拔除管/罩的时间和麻醉恢复室停留时间。结果喉罩组患者进入手术室至手术开始时间低于气管插管组（P〈0.05）;喉罩组和气管插管组T1时平均动脉压（MAP）、心率显著低于T0时（P〈0.05）;气管插管组T2和T4时MAP和心率较T0时显著升高（P〈0.05）;组间比较T2和T4时气管插管组MAP和心率均显著高于喉罩组（P〈0.05）。置入管/罩及拔管/罩时气管插管组呛咳发生率分别为25%和84%,明显高于喉罩组的0和4%（P〈0.05）。气管插管组手术结束至拔除通气装置的时间高于喉罩组（P〈0.05）。结论喉罩通气用于成人中耳显微手术气道管理,易于维持血流动力学稳定,有效避免了拔管时呛咳。

Application of laryngeal mask airway ventilation in otologic microsurgery of adult patients

Objective To evaluate the safety and efficacy of the larygeal mask airway ventilation in general anesthesia in adult patients undergoing otologic microsurgery . Methods One hundred American Standard of Anesthesiologist （ ASA）Ⅰ-Ⅱadult patients who underwent otologic microsurgery were randomly divided into two groups ：laryngeal mask group （group LMA, n =50） and endotracheal intubation group （group ETT, n =50）.Time from entering the operating room to surgery start time and the duration of surgery were recorded .Mean artery pressure （ MAP） and HR were recorded before anesthesia induction （ T0 ） , before intubation （ T1 ） , after intubation immediately （ T2 ） , before extubation （ T3 ） , and after extubation immediately （ T4 ） .During intubation and extubation , the extent of cough reflex was compared .Time from end of the surgery to extubation and time spent in postoperative care unit were also of interest.Results Time from entering the operating room to surgery start time was shorter in group LMA （P〈0.05）. MAP and HR at T1were both less than those at T0 in two groups （P〈0.05）.In group ETT,MAP and HR at T2 and T4 were higher than those at T0（P〈0.05）.In group ETT,MAP and HR were higher than those in group LMA at T 2 and T4 （P〈0.05）.Incidence of cough was 25%in group ETT versus 0 in group LMA during intubation （P〈0.05）.Incidence of cough in grouop ETT was 84%versus 4%in group LMA （P〈0.05）.Time from the end of surgery to extubation in group LMA was 4 min shorter than that in group ETT .Conclusions Laryngeal mask ventilation for adult patients undergoing otologic microsurgery was benefit for hemodynamic stability and avoiding coughing during emergence.