喉罩置入和视可尼喉镜气管插管在全麻诱导期对循环和BIS影响的比较

目的比较全麻诱导期喉罩置入和视可尼气管内插管对患者心血管反应和脑电双频指数(BIS)的影响。方法选择择期行鼻内窥镜全麻手术的患者60例,ASAⅠ～Ⅱ级,随机分为喉罩置入组(Ⅰ组)和视可尼气管插管组(Ⅱ组),每组30例。麻醉诱导和维持采用靶控输注丙泊酚和瑞芬太尼全静脉麻醉。比较各组患者诱导前(T1),诱导后(T2),喉罩置入或视可尼气管插管后即刻(T3)、1min(T4)、3min(T5)、5min(T6)时平均动脉压(MAP)、心率(HR)、BIS值的变化。结果Ⅰ组喉罩置入前后MAP、HR、BIS值组内比较差异无统计学意义(P>0.05);Ⅱ组T3、T4、T5的MAP、HR较T2时点差异无统计学意义(P>0.05),但BIS值明显升高(P<0.05),且在T3、T4、T5时明显高于Ⅰ组(P<0.05)。结论在相同麻醉深度下,全麻诱导期使用喉罩置入或视可尼气管内插管均可保持患者循环系统稳定,但视可尼气管内插管可使中枢神经兴奋性增高。

Comparison of hemodynamic changes and bispectral index during induction of general anesthesia induced by LMA insertion or tracheal intubation with Shikani optical stylet

Objective To compare the changes of hemodynamic and bispectral index(BIS) during induction of general anesthesia induced by LMA insertion or tracheal intubation with Shikani optical stylet.Methods Sixty patients,ASA Ⅰ～Ⅱ,undergoing endoscopic sinus surgery were randomly divided into two groups:LMA insertion Group(Group Ⅰ) and Shikani intubation Group(Group Ⅱ).Thirty cases were included in each group.Anesthesia were inducted and maintained by target control injection of propofol and remifentanil(TIVA).Before and after induction(T1 and T2),after LMA insertion or tracheal intubation immediately(T3),1 min(T4),3 min(T5),5 min(T6),mean values of MAP,HR and BIS were compared within and between the two groups.Results No significant difference were detected in the mean value of MAP,HR and BIS before and after LMA insertion in patients in Group Ⅰ(P > 0.05).There were no significant difference in the mean value of MAP and HR before and after tracheal intubation in Group Ⅱ(P > 0.05).But T3,T4 and T5 after intubation,the BIS value was significantly raised than that of before intubation in Group 6.5±1.8(P < 0.05).Compared with Group Ⅰ,BIS value was also raised at the time of T3,T4 and T5(P < 0.05).Conclusions Hemodynamic stability could be maintained during induction of general anesthesia either by LMA insertion or tracheal intubation with Shikani optical stylet in similar deep status of anesthesia.But slight stimulation of the central nervous system can be induced by tracheal intubation.