双管喉罩通气麻醉在老年人侧卧位手术中的临床研究

目的观察间歇正压（IPPV）通气下双管喉罩通气麻醉在老年人侧卧位手术中应用的安全性、有效性。方法选择侧卧位行全髋关节置术患者60例，ASA1Ⅰ～Ⅲ级，年龄〉60岁，随机分为双管喉罩组（P组，30例）和气管插管组（T组，30例）。记录进入手术室连接监测5min后（T0）、插管前即刻（T1）、插管后即刻（T2）、插管后3min（T3）、拔管时（T4）和拔管后5min（T4）的MBP和HR，两组侧卧位正压通气10min（Ta）、手术开始后60min（Th）、术毕（Tc）时的分钟通气量（MV）、潮气量（VT）、气道峰压（Pmax）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）；两组拔管期的不良反应及术后并发症。结果P组插管后即刻（T2）及拔管时（T4）的HR、MBP均较T组降低（P〈0．05）；两组分钟通气量（MV）、潮气量（VT）、气道峰压（Pmax）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）比较差异无统计学意义（P〉0．05）。拔管期呛咳和体动发生率T组明显高于P组，差异有显著性（P〈0．01），T组术后咽喉痛发生率高（P〈0．05）。结论本观察显示双管喉罩通气全麻可以达到与气管插管一样满意的通气效果，且双管喉罩组插管期和拔管期心血管应激反应更小，拔管期呛咳发生率明显降低。

Clinical study on proseal laryngeal mask airway in old patients of lateral operative position

Objective To observe the salty and efficacy of proseal laryngeal mask airway in old patients who received operation at lateral position. Method 60 patients who would have total hip joint replacement operation, age 〉 60, were randomly divided into laryngeal mask group（ P group, n = 30） and tracheal tube group （ T group, n = 30）. During the operation, the mean blood pressure （MBP） and heart rate （HR） were recorded at TO （5 minutes after patient was monitored） , T1 （ immediate before intubation ） , T2 （ immediate after intubation） , T3 （3 minutes after intubation） , T4 （extubation） and T5 （5 minutes after extubation）. The minute volume （ MV ） , tidal volume （VT） , maximum airway pressure （ Pmax ） , pulse oxygen saturation （ SpO2 ） and end - tidal carbon dioxide pressure （PET CO2 ） were recorded at Ta （10 minutes after ventilation at lateral position）, Tb （60 minutes afer operation beginning） , and Tc （immediate at the ending of operation ）. The side effects and complication associated with intubation also were recorded. Results MBP and HR in P group were lower compared with T group at T3 and T4 （ P 〈 0. 05 ） ; there were no significant differences between two groups in MV, VT, Pmax, SpO2 and PETCO2 （P 〉 0. 05）. The incidence.of bucking and body movement during extubation were significantly higher in T group（ P 〈 0. 01 ） and the incidence of sore throat after operation was also higher in T group （ P 〈 0. 05 ） compared with that in P group. Conclusion Proseal laryngeal mask has similar ventilation efficacy in general anesthesia compared with tracheal tube, and has lower cardiovascular reaction during intubation and extubation. The incidence of bucking decreased significantly during extubation by using proseal laryngeal mask.