第三代喉罩在老年患者全身麻醉中的应用

目的探讨第三代喉罩应用在老年患者全身麻醉中的可行性和安全性。方法老年全麻手术患者100例（60～90岁）,ASAⅠ～Ⅲ级,随机均分成第三代喉罩组和气管插管组。在麻醉诱导前（T0）、插入喉罩/气管导管前（T1）、插入喉罩/气管导管后即刻（T2）、插入喉罩/气管导管后5min（T3）、手术开始时（T4）、拔管后即刻（T5）记录收缩压（SBP）、舒张压（DBP）、心率（HR）。每组随机抽取20例患者于T0、T1、T2、T4、T5时应用高效液相色谱分析仪测定血浆肾上腺素（AE）、去甲肾上腺素（NE）、多巴胺（DA）水平。并记录患者相关并发症。结果气管插管组T2时SBP、DBP、HR显著高于第三代喉罩组（P〈0.05）;T2、T4时AE、NE、DA均显著高于第三代喉罩组（P〈0.05）。气管插管组并发症显著多于第三代喉罩组（P〈0.05）。结论老年人全身麻醉通气使用第三代喉罩优于气管插管,易于维持血流动力学稳定,应激反应轻微,并发症少。

Application of Proseal Laryngeal Mask Airway in Elderly Patients during General Anaesthesia

Objective To observe the efficacy and safety of proseal laryngeal mask airway（PLMA） in elderly patients during general anaesthesia. Methods One hundred patients aged 60-90 years old（ ASA Ⅰ -Ⅲ ） were randomly divided into group PLMA （proseal laryngeal mask airway） and group EI （endotracheal intubation）. Systolic blood pressure （SBP） , diastolic blood pressure （DBP） ,heart rate （HR） were recorded before anesthesia induction （T0 ）, before intubation （T1）, after intubation immediately （ T2 ）, at 5 min after intubation （ T3 ） , at beginning of the operation （ T4 ） , after extubation immediately （ T5 ）. Blood samples were taken in 20 patients from each group at 5 time points for the measurement of epinephrine （AE）, norepinephrine （NE）and dopamine（DA） levels with high performance liquid chromatography. The complication was recorded. Results SBP,DBP and HR in group EI were significantly higher than those in group PLMA at T2 （ P 〈0. 05 ）. AE, NE and DA in group EI were significantly higher than those in group PLMA at T2 and T4 （ P 〈 0.05 ）. The complication in group EI were significantly more than that in group PLMA（ P 〈 0.05 ）. Conclusion Ventilation with PLMA in elderly patient during general anaesthesia is better than EI in keeping stable hemodynamics and producing less stress responses and adverse effects.