喉罩用于隆胸手术患者气道管理的效果

摘要]目的观察喉罩通气全凭静脉麻醉用于隆胸术的临床效果。方法选择ASAI～Ⅱ级女性隆胸手术患者40例，年龄23—42岁；体重45—67kg；随机分为气管内插管组（A组，n=20）与喉罩组（B组，n=20）两组，A组静脉注射芬太尼0．2mg、丙泊酚2．0—2．5mg／kg、阿曲库铵0．15mg／kg诱导，插入气管导管；B组静脉注射芬太尼0．1mg、丙泊酚2．0～2．5mg／kg诱导，插入普通型喉罩，两组均接麻醉机行IPPV模式控制呼吸，两组均以微量泵持续泵入丙泊酚6～9tLg／（kg·min），瑞芬太尼0．1—0．15μg/（kg·min）维持麻醉，A组间断静脉注射阿曲库铵，手术结束前10min停止用药，待受术者呼之能应，呼吸良好时拔除气管导管或喉罩。观察记录两组患者气管内插管和喉罩置入时间及置人情况、监测病人麻醉前（11D）、插管（插喉罩）后即刻（T1）、分离胸部肌肉时（他）、植入假体时（T3）、喉罩和气管导管拔除后即刻（T4）时的MAP、HR及SpO：的变化、通气状态以及操作时及术后的相关不良反应。结果A组1次成功完成气管内插管率与B组1次成功置入喉罩率无显著性差异（P〉0．05）；A组诱导时芬太尼用量显著多于B组（P〈0．05）；A组气管内插管后即刻（T1）以及拔管后即刻（rr4）的MAP及HR较诱导前显著升高（P〈0．05），分离胸部肌肉时（T2）与植入假体时（T3）SBP、DBP、MAP和HR值均低于麻醉前，而B组T1、T2、T3时均较诱导前低（P〈0．05）；T4与诱导前相比无明显差异（P〉0．05）。A组插管时发生口腔粘膜出血及术后发生咽喉疼痛及呛咳的患者明显多于B组（P〈0．05）。结论与气管内插管全麻相比，喉罩通气全凭静脉麻醉施行隆胸手术，麻醉效果更满意、循环更稳定、并发症更少，术后恢复更舒适。

Efficacy of Laryngeal Mask Airway in Patients Undergoing Augmentation Mammaplasty

Objective To assess the efficacy of laryngeal mask in airway management for patients un- dergoing augmentation mammaplasty. Methods All 40 female patients（ASA I - II ）, aged between 23 - 42 years and weight between 45 - 67 kg who had been scheduled for augmentation mammaplasty were random- ized into 2 groups （ n = 20 for each） ： tracheal intubation group （ group A ） and LMA group （ group B ）. The pa- tients of group A were infused fentanyl 0.2rag and propofol 2.0 ~ 2.5 mg/kg and atracurium 0.15 mg/kg. The patients of group B were infused fentanyl 0.1 mg and propofol 2.0 - 2.5 mg/kg, then placed endotracheal tube or laryngeal mask airway. Intravenous administration of propofol 6 - 9 Ixg/（ kg ~ rain） and remifentanil 0.1 ~ 0.15 ~g/（kg ~ min） were lasted to ten minutes before the end of the operation. The data were kept in two groups regarding the successful rates, time consumption for intubation and LMA placement, the SBP, DBP, MAP,HR were recorded in different time points. Complications including oral mueosal bleeding, bucking and sorethroat were recorded. The duration of surgery and time for extubation and consciousness recovery were also recorded in the two groups. Results All patients were satisfied with anesthesia. There was no significant difference between the two groups concerning successful intubation and LMA placement （P 〉 0.05 ）. Group A of MAP and HR during endotracheal intubation and extubation induced a significant rise（ P 〈 0.05 ）. The inci- dence of bucking and sore throat were significantly lower in group B than in group A（ P 〈 0.05 ）. There was no difference in extubation time and waking time （ P 〉 0.05 ）. Conclusion LMA can be safe and effective for airway management in patients undergoing augmentation mammaplasty under total intravenous anesthesia. It is worth widely using for its excellent ventilation, safety, efficacy and fewer complications after the mask removal.