喉罩与气管插管在全麻或复合硬膜外阻滞时的心率和血压改变

The haemodynamic response to laryngeal mask airway: a comparison with endotracheal intubation under general anesthesia or combined with epidural block

目的 比较喉罩与气管插管用于全麻或全麻复合硬膜外阻滞患者的HR和BP变化。方法 妇科手术 80例 ,随机分为全麻气管插管 (T)组、全麻喉罩 (L)组、硬膜外阻滞 +全麻气管插管(ET)组、硬膜外阻滞 +全麻喉罩 (EL)组 ,每组 2 0例。硬膜外阻滞用 1%利多卡因 +0 15 %丁卡因。全麻诱导咪唑安定 2mg、芬太尼 0 2mg、丙泊酚 1 5mg/kg、琥珀胆碱 1 5mg/kg后插气管导管或喉罩。全麻维持 5 0 %N2 O +O2 +异氟醚 ,静注阿曲库铵、芬太尼。于麻醉前 (基础 ,入室静卧 10min后 )、插管后 1min、切皮、进腹探查后 5min、拔管后 1min记录MAP、SpO2 、HR、PETCO2 。结果 插管时HR和MAP均低于基础值 ,而两组喉罩HR低于插气管导管者 ,硬膜外复合全麻喉罩组MAP低于气管插管组。切皮时两组全麻MAP高于复合硬膜外组。探查时两组复合硬膜外者HR和MAP均低于基础值 ,且MAP低于单纯全麻者 (P <0 0 5 )。拔管时各组HR均显著高于基础值 ,MAP未复合硬膜外者显著高于基础值。结论 (1)插喉罩对BP和HR的影响不如气管导管剧烈 ;(2 )复合硬膜外阻滞时气管插管或喉罩置入应激反应轻 。

Objective To compare the haemodynamic response to the laryngeal mask airway(LMA) insertion with endotracheal intubation in general anesthesia with or without epidural block(EB) in obstetric patients.Methods Eighty adult patients scheduled for selective obstetric surgery under general anesthesia were randomly assigned to one of four groups (n=20 for each ). Patients in group T were tracheal intubated under(GA), in group L laryngeal mask airway insertion under GA; in group ET, tracheal intubation under GA+EB and in group EL, LMA under GA+EB. 1% lidocaine and 0.15% tetracaine were used for epidural anesthesia.General anesthesia was induced with midazolam 2 mg, fentanyl 0.2 mg,propofol1.5 mg/kg and succinylcholine 1.5 mg/kg intravenously,and was maintained with 50% N 2O in oxygen and isoflurane. Fentanyl and atracurium were given intravenously as required.Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), SpO 2 and P ETCO 2 were measured before anesthesia,at 1min after endotracheal intubation or laryngeal mask airway,after skin incision, abdominal surgical exploration,1min after tracheal extubation or LMA removal.Results HR and MAP were all decreased during induction and insertion of the tube or LMA. HR in the two LMA groups was lower than that in the two intubation groups. MAP was lower in group EL than that in group ET. After Skin incision, MAP was higher in two groups without epidural. During exploration, HR and MAP in the two epidural groups decreased and MAP was also lower than that in the groups without epidural. During extubation HR increased significantly in all groups compared to the baseline. MAP was also increased in the two epidural groups.Conclusion The effect of LMA on haemodynamics was not as great as that of endotracheal intubation. The epidural block can attenuate the cardiovascular stress response to endotracheal intubation, insertion of LMA and surgical exploration.