深麻醉拔除气管导管-喉罩替代通气对老年高血压患者苏醒期应激反应的影响

目的 探讨术毕深麻醉下拔除气管导管(拔管)-喉罩替代通气对老年高血压患者苏醒期应激反应的影响.方法 2008年10月至2009年6月择期行上腹部手术患者40例,其中男性28例,女性12例,年龄65～78岁,平均(69±5)岁;美国麻醉医师协会分级Ⅰ～Ⅱ级,体质量51～74kg.将患者随机分为2组:清醒拔管组(TT组,20例)和深麻醉下拔管-喉罩替代组(LM组,20例).记录两组麻醉诱导前(T0)、拔管或拔除喉罩前吸痰时(T1)、拔管或拔除喉罩即刻(T2)、拔管或拔除喉罩后5 min(T2)、10 min(T4)和15 min(T5)时平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)和呼吸末二氧化碳分压(PETCO2),并计算心率收缩压乘积(RPP);同时于T0、切皮即刻、T2及T3四个时点测定血糖和皮质醇浓度,并记录LM组喉罩替代前后上述指标水平;观察患者从自主呼吸恢复至拔管后15 min的气道反应情况.结果 TT组患者清醒拔管前后T1～T3时点MAP、HR、RPP较术前明显升高(P＜0.05),LM组患者清醒拔除喉罩前后上述指标变化差异无统计学意义(P＞0.05),患者深麻醉下拔管-喉罩替代通气过程MAP、HR、RPP无明显变化(P＞0.05).LM组中、重度呛咳发生率低于TT组(P＜0.05).与T0比较,两组血糖水平与皮质醇浓度水平自插管(喉罩)后均不同程度上升,TT组于T2显著上升(P＜0.05),并于T3达峰值.结论 术毕深麻醉下拔管-喉罩替代通气能降低老年患者应激反应、维持血流动力学稳定,提高全身麻醉术后苏醒质量.

Effect of exchange of tracheal tube for laryngeal mask airway(LMA) on intratracheal extubation stress response under deep anesthesia level after surgery in elderly patients with hypertension

Objectiye To investigate the effect of exchange of tracheal tube for a laryngeal mask airway (LMA) on intratracheal extubation stress response under deep anesthesia level after surgery in elderly patients with hypertension. Methods From October 2008 to June 2009,40 hypertension patients aged from 65 to 78 years scheduled for upper abdominal surgery were randomly devided into 2 groups, one was extubated intratracheal tube when being awake( group TT, n = 20)and the other was extubated and exchanged for LMA under deep anesthesia( group LM, n = 20). The American Society of Anesthesiologists (ASA) of the patients were Ⅰ or Ⅱ. The data of mean arterial pressure (MAP) ,heart rate(HR) ,pulse oxygen saturation ( SPO2 ), end-tidal carbon dioxide tension ( PET CO2 ) and rate pressure product (RPP) were recorded before induction of anesthesia ( T0 ), suction (T1) and at 0 ( T2 ), 5( T3 ), and 10 ( T4 ) and 15 min ( T5 ) after extubating tracheal tube or LMA in two groups. The indices mentioned above also were recorded before and after extubation in group LM. Blood samples were taken at To, skin incision, T2, T3, for determination of serum concentrations of blood glucose and cortisol. The airway adverse events in the recovery period were recorded. Results Compared with group LM, MAP, HR and RPP were significantly higher at T1 , T2, T3than T0 in group TT(P ＜0. 05). There was no significant difference in the indices mentioned above during extubated intratracbeal tube and exchanged for LMA under deep anesthesia in group LM ( P ＞ 0. 05 ). The incidence rate of glossoptosis in group TT was significantly higher than those in group LM ( P ＜ 0. 01 ), while complications, such as cough, bucking, breath holding during the recovery stage in group TT were more than those in group LM ( P ＜ 0. 05 ). Compared with the baseline value, blood glucose and cortisol concentration level were significantly increased in group TT than in group LM (P ＜ 0. 01 ). Conclusions Exchange of tracheal tube for LMA under deep anesthesia during recovery stage can decrease the stress response during the recovery stage and attenuate the harmful response of respiratory tract. It is suitable for the elderly patients with hypertension.