第四代喉罩用于神经外科侧卧位手术中的临床效果

目的 探讨第四代喉罩用于神经外科侧卧位手术中的安全性和有效性.方法 选择神经外科侧卧位手术患者80例,随机分为喉罩组（L组,40例）和气管插管组（E组,40例）.记录基础值（T1）、插管前即刻（T2）、插管后即刻（T3）、插管后3 min（T4）、拔管前即刻（T5）和拔管后即刻（T6）和拔管后3 min （T7）的HR、MAP及SpO2变化.观察两组麻醉效果和术后并发症情况.结果 与T1时比较,T2～T4时L组MAP和T2、T4时T组MAP明显降低（P＜0.05）.与E组比较,L组T3、T4、T5、T6时HR明显减慢、MAP明显降低（P＜0.05）.拔管期E组呛咳发生率明显高于L组（P＜0.05）,术后咽喉痛、声音嘶哑两组比较差异无统计学意义（P＞0.05）；两组均未发生误吸.结论 第四代喉罩可安全应用于侧卧位神经外科手术,可达到和气管插管一样满意的通气效果,且插管与拔管期间对心血管的影响更小,拔管期呛咳发生率减少.

The fourth generation of laryngeal mask airway in lateral position neurosurgical procedure

Objective To observe the safety and efficacy of the fourth generation of laryngeal mask airway in lateral position neurosurgical procedure.Methods 80 ASA Ⅱ or Ⅱ patients aged 18-55 undergoing neurosurgical procedure in lateral position were randomly divided into group L （receiving LMA） and group E （receiving endotracheal tube） for airway management.HR,MAP and SpO2 were recorded before intubation （base values,T1）,immediately before intubation （T2）,immediately after intubation （T3）,3 min after intubation （T4）,immediately before extubation （T5）,immediately after extubation （T6） and 3 min after extubation （T7）.Anesthesia effect and postoperation complications were recorded.Results Compared with T1,MAP at T2-T4 in group L and MAP at T2,T4 in group E decreased significantly （P ＜ 0.05）.Compared with group E,HR at T3-T6 in group L slowed,MAP at T3-T6 decreased （P ＜ 0.05）.Group E had a higher coughing incidence before extubation （P ＜ 0.05）.There were no significant differences in the incidences of sore throat and hoarse between two groups.No aspiration occurred.Conclusions The fourth generation of laryngeal mask airway intubation can provide the same safe and effective ventilation as endotracheal intubation in lateral position neurosurgical procedure.Furthermore,it is superior to endotracheal intubation in insection response and coughing response.