喉罩对脑室镜手术患者呼吸道保护作用的观察

Application of laryngeal mask for airway protection during ventriculoscopic operation

目的比较喉罩与气管内插管用于脑室镜手术患者呼吸道保护的安全性。方法选择2003年7-12月行脑室镜手术的患者40例(美国麻醉医师协会Ⅰ～Ⅱ级),随机分为喉罩组和气管内插管组,每组20例患者。手术前所有患者均肌内注射阿托品0.5mg,咪哒唑仑3mg。麻醉诱导静脉注射咪哒唑仑2mg,芬太尼0.2mg、丙泊酚2mg/kg,气管内插管组复合静脉注射罗库溴铵0.8mg/kg后建立人工呼吸道。麻醉维持静脉注射雷米芬太尼0.2μg/(kg·min),丙泊酚0.7mg/(kg·min),气管内插管组复合静脉注射罗库溴铵30μg/(kg·min)。术中监测血压、心率、脉搏、氧饱和度和呼气末二氧化碳分压,记录呛咳、体动、呕吐和误吸等不良反应,以及人工呼吸道建立、手术和复苏时间。术后每日行纤维喉镜检查,记录上呼吸道麻醉并发症。结果气管内插管组于人工呼吸道建立即刻、1min和3min时平均动脉压及心率均明显高于喉罩组(P<0.05或P<0.01)。手术中气管内插管组11例发生呛咳(6例)或吞咽(5例),而喉罩组无不良反应发生,组间差异具有显著性意义(P<0.05)。两组人工呼吸道建立和麻醉复苏时间分别为:喉罩组(2.3±0.6)min、(7.3±1.6)min,气管内插管组(3.7±1.3)min、(10.9±3.1)min,前者显著低于后者(P<0.01)。手术后,气管内插管组有7例声带轻度水肿。

Objective To compare the clinical safely of laryngeal mask with that of endotracheal intubation in patients during ventriculoscopic operation for airway protection. Methods Forty patients (American Society of Anesthesiologists Ⅰ-Ⅱ) performed vetriculoscopic operation during July to December 2003 were randomly divided into laryngeal mask group (n = 20) and endotracheal intubation group (n = 20). Atropine (0.5 mg) and midazolam (3 mg) were IM injected routinely before operation in all patients. Anesthesia was induced by midazolam (2 mg), fentany (0.2 mg) and porpofol (2 mg/kg) in both groups, while additional rocuronium (0.8 mg/kg) was injected in endotracheal intubation group for establishing artificial airway. Anesthesia was maintained by IV injection of remifentaniliva 0.2 μg/(kg·min) and propofol 0.7 mg/(kg·min) in both groups, while rocuronium 30 μg/(kg·min) was also IV injected in patients of endotracheal intubation group. The blood pressure (BP), heart rate (HR), pulse, oxygen saturation and end expiratory CO2 pressure were monitored. The adverse effects such as cough, body movement, vomit, incorrect inhalation were recorded during operation, the time of artificial airway establishing, operation and resuscitation were also recorded. All the patients were checked everyday postoperatively by fibrolaryngoscope to record the anesthetic complication of upper airway. Results The mean arterial pressure, HR of patients in endotracheal intubation group were significantly higher than that in laryngeal mask group at the points of artificial airway insertion, 1 min and 3 min thereafter (P < 0.05 or P < 0.01). Eleven patients in endotracheal intubation group occurred irritating cough (n = 6) and swallowing (n = 5), while none of these adverse effects occurred in laryngeal mask group, the difference between two groups was significant (P < 0.05). The time of artificial airway establishing and resuscitation were (2.3±0.6) min, (7.3±1.6) min in patients of laryngeal mask group and (3.7±1.3) min, (10.9±3.1) min in endotracheal intubation group, which were significantly lower in former group than that in later (P < 0.01). Seven cases occurred mild edema of vocal cord in endotracheal intubation group but none in laryngeal mask group, the difference between two groups was significant (P < 0.01). Conclusion The advantages of laryngeal mask in ventriculoscope operation are quick induction of anesthesia, rapid resuscitation, less damage of upper airway mucosa and rare occurrence of anesthetic complication. The airway protection effect of laryngeal mask is superior to that of endotracheal intubation.