无肌松喉罩通气全身麻醉在老年患者下腹下肢手术中的应用效果及安全性评价

目的观察无肌松喉罩通气全身麻醉在老年患者下腹部、下肢手术中应用的效果及安全性.方法择期行下腹部或下肢手术的老年患者120例,随机分成无肌松喉罩组(A组)、肌松气管插管组(B组).分别记录两组患者麻醉诱导前(T0)、置入喉罩或气管导管即刻(T1)、置喉罩或气管导管后5min(T2)、置喉罩或气管导管后30min(T3)、置喉罩或气管导管后60min(T4)、拔出喉罩或气管导管后即刻(T5)及拔喉罩或气管导管后5min(T6)的心率(HR)、平均动脉压(MAP)及气道压力(Ppeak)的变化情况;记录患者麻醉时间、术后吞咽反射恢复时间及拔喉罩或气管导管时间(术毕到拔除喉罩或气管导管);随访拔除喉罩或气管导管后30min、8h及24h咽喉痛的发生情况.结果两组患者年龄、体重指数(BMI)、性别构成、麻醉时间和手术种类等方面差异均无统计学意义(P>0.05);两组在T0、T2、T3、T4各时间点HR和MAP差异均无统计学意义(P>0.05);B组在T1、T5、T6时间点HR和MAP显著高于A组,差异均有统计学意义(P<0.05);两组各时间点气道压力差异无统计学意义(P>0.05);A组患者术后咽喉反射恢复时间、拔喉罩时间均早于B组,差异有统计学意义(P<0.05),A组术后咽喉痛发生率低于B组(P<0.05).结论无肌松喉罩通气全身麻醉应用可以减轻围术期麻醉操作对合并多种内科疾病的老年下腹下肢手术患者心血管系统的刺激,有利于此类患者的血流动力学的稳定,且苏醒早,术后肺部并发症少,术后咽喉痛的发生率低,安全可靠.

Objective To explore the efficacy and safety of laryngeal mask airway without muscle relaxant in lower abdominal and lower limb surgery in elderly patients.Methods A total of 120 elderly patients who underwent lower abdominal or lower limb surgery were randomly divided into the laryngeal mask airway without muscle relaxant group(group A)and the intubation with muscle relaxant group(group B).Variations in heart rate(HR),mean arterial pressure(MAP)and airway pressure(Ppeak)in the two groups were monitored at different rimes prior to anesthesia(TO),immediately after intubation or indwelling of LMA(T1),5min after intubation(T2),30min after intubation(T3),60min after intubation(T4),immediately after extubation or withdrawal of LMA(T5),5min after extubation or LMA(T6).The duration of anesthesia,time to recovery,time to extubation were also recorded.30min,8h,24h after intubation of postoperative throat pain was compared in patients in the two groups.Results The results of the age,body mass index(BMI),gender composition,duration of anesthesia and type of surgery between the two groups did not demonstrate any significant difference.The monitoring of MAP,HR and Sp02 in the two groups at each time point of TO,T2,T3 and T4 were no significant differences(P>0.05).HR and MAP in the group B were observed at different times(T1,T5,T6)were higher than those in group A,with statistically significant differences(P<0.05).There was no significant difference in airway pressure between the two groups at each time point(P>0.05).Time to recovery,time to extubation and occurrence of throat pain in the A group were significantly less than those observed in the B group(P<0.05).Conclusion The method of using laryngeal mask airway without muscle relaxant in lower abdominal and lower limb surgeries is a superior method that offers stable hemodynamics and less throat pain in elderly patients,which is safe and reliable.