喉罩与气管插管用于全麻乳腺癌根治术的比较

Comparison of laryngeal mask airway with endotreacheal intubation in patients undergoing radical mastectory

目的比较喉罩和气管插管用于全麻乳腺癌根治术对患者血流动力学、呼吸功能和应激激素的影响。方法40例ASAⅠ或Ⅱ级在全麻下实施乳腺癌根治术的患者,随机均分为喉罩组和气管内插管组。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)、10min(T4)、15min(T5)和乳腺癌根治术切皮时(T6)、拔管后即刻(T7)记录SBP、DBP、HR。应用BICORE呼吸功能监测仪监测呼吸功能16项指标,选择T0、T3、T4、T5、T7时记录吸气潮气量(VTI)、呼气潮气量(VTE)、分钟通气量(VE)、吸气峰流速(PIFR)、呼气峰流速(PEFR)、吸气峰压(PIP)和平均气道阻力(RAWM)。每组随机抽取10例患者于T0、T1、T2、T6、T7时应用高效液相色谱分析法测定血浆肾上腺素(AE)、去甲肾上腺素(NE)、多巴胺(DA)水平。结果气管插管组T2时SBP、DBP、HR显著高于喉罩组(P<0.05);VTI、VTE、VE、PIFR、PEFR、PIP和RAWM组间差异无统计学意义,AE、NE、DA在T2、T7时均显著高于喉罩组(P<0.05)。结论全麻喉罩通气用于乳腺癌根治术患者优于气管插管,易于维持血流动力学稳定,应激反应轻微,全麻后恢复平稳。

Objective To compare the effects of laryngeal mask airway （LMA） and endotreacheal intubation （ET） on hemodynamics, respiratory function and stress responses in patients undergoing radical mastectory. Methods Forty patients （ASA class Ⅰ or Ⅱ ）, scheduled for selective radical mastectory under general anesthesia were allocated randomly to either LMA group （n=20） or ET group （n=20） with mechanial ventilation. SBP, DBP, and HR were recorded before anesthesia induction（T0 ） ,before intubation（T1 ） ,after intubation immediately（T2 ） ,at 5 min（T3 ）, 10 min（T4 ）, 15 min（T5 ） after intubation,beginning of the elective radical mastectory（T6 ）, after extubation immediately（T7）. The inspiratory and expiratory tidal volume （VT1 ） and （VTE ）, minute ventialtion （VE）, peak inspiratory and expiratory flow rate （PIFR） and （PEFR）, peak inspiratory pressure （PIP） and mean airway resistance （RAWM） were recorded. Blood samples were taken in 10 patients from each group at 5 time points for the measurements of epinephrine （AE） ,norepinephrine （NE） ,and dopamine （DA） levels with high performance liquid chromatography. Results In group ET, SBP, DBP, HR and MAP were significantly higher than those in group LMA at T2 （P〈0.05）. VT1, VTE, VE, PIFR, PEFR, PIP and RAWM did not differ between the two groups. AE, NE and DA were also significantly higher in group ET than those in group LMA at T2 and T7 （P〈0.05）. Conclusion Ventilation with LMA in patients undergoing radical mastectory is better than ET in keeping stable hemodynamics and producing less stress responses with smoth recovery from genenal anesthesia.