喉罩复合硬膜外麻醉在合并肺部疾患老年人的麻醉中的应用

目的评价喉罩复合硬膜外麻醉在合并肺部疾患老年人的麻醉中可行性。方法择期行胃大部切除术的高龄患者50例，肺功能MVV占预计值均在50％～30％之间。随机分为两组：喉罩组（L组）气管导管组（T组），硬膜外麻醉后全麻醉诱导，L组置入PLMA，T组置入气管导管。术中通过BIS的监测把麻醉深度控制相同深度。观察与监测记录麻醉前（T1）、麻诱导期（T2）、喉罩（气管导管）置入（T3）、手术麻醉维持期（T4）、停药时（T5）、睁眼时（T6）、拔除喉罩（气管导管）时（T7）、拔除喉罩（气管导管）后5min（T8）的SBP、DBP、HR，自主呼吸恢复时间（M1）、停药-睁眼时间（M2）及停药．拔除喉罩时间（M3）、丙泊酚总量（ml）G发生烦躁的例数（N1），保留导管发生数（N2），术后咽痛例数（N3），肺部并发症例数（N4）。结果L组患者在麻醉诱导、手术维持、拔除喉罩过程中血压、心率均有波动，但和麻醉前相比无显著性差异（P〉0．05），T组中，在插管时血压及心率变化较大，与诱导时相比具有显著性意义。在手术结束时、睁眼时及拔管时血流动力学变化升高，与麻醉前比较有显著性意义（P〈0．05）。两组患者在自主呼吸恢复时间，睁眼时间和拔管时间比较均有显著性差异（P〈0．05），且L组用药量比T组少两者比较用显著性差异（P〈0．05）在两组中发生烦躁的例数，保留导管发生数，术后咽痛例数，肺部并发症例数的比较中也有显著性差异（P〈0．05）。结论喉罩复合硬膜外麻醉对老年人合并有肺部疾患的上腹部手术是较好的麻醉方式，可以加快术后恢复，减少肺部并发症。

The application of general anesthesia of laryngeal mask airway with epidural block in aged Patients with pulmonary complication

Objective To study the feasibility of general anesthesia of laryngeal mask airways with epidural block in aged Patients with pulmonary complication. Methods 50 cases of such aged patient with pulmonary complication undergoing Subtotal Gastrectomy were divided into laryngeal mask airway group（ Group L）and tracheal intubation group（group T）. The changes of HR, SBP, DBP and BIS were recorded at the eight times during anesthesia. Time to the recovery of spontaneous breathing, time to eye opening, time to endotracheal extubation, time to the recovery of orientation, total dose of propofol and the incidence of postoperative complications were recorded. Results The changes of HR,SBP,DBP were not significantly different in group L. The changes of HR, SBP, DBP at the time of intubation, eye opening and extubation were significantly different to preanesthesia in group T（ P 〈 0. 05 ）. The time to the recovery of spontaneous breathing, to eye opening, to endotracheal extubation, to the recovery of orientation were significantly different in two groups. Total dose of propofol group L was significantly less than group T. The incidence of postoperative complications group L was significantly lower than group T. Conclusion General anesthesia of laryngeal mask airway with epidural block was good way in aged patients with pulmonary complication. It was beneficial to recovery of post-operation and reduced postoperative complications.