喉罩对颈总动脉和颈内动脉血流动力学的影响

Effects of laryngeal mask airway on the hemodynamics of common carotid artery and internal carotid artery

目的研究喉罩对颈总动脉（CCA）和颈内动脉（ICA）内径、血流速率和血流量等血流动力学参数的影响。方法随机选择择期全麻下行腹腔镜胆囊切除术患者60例，为美国麻醉医师协会（ASA）Ⅰ～Ⅲ级。根据不同年龄分为中青年组（A组，20～59岁）和老年组（B组，60～85岁）。按不同的喉罩套囊内压力将A组和B组分为4个亚组，即A1、B1（套囊内压为20～30cmH2O）（1cmH2O=0．098kPa）和A2、B2（套囊内压为40～50cmH2O），每组15例。所有患者术毕后送入ICU复苏，尚未清醒时拔除气管导管，而后置入喉罩。记录置入喉罩前（Tn），置入喉罩后3min（T1）、10min（T2）和拔除喉罩后（L）各时点CCA和ICA的内径、血流速率和血流量等血流动力学参数以及生命体征参数。结果CCA、ICA的内径和CCA血流量的基础值B组比A组要大（P〈0．05）。与T0比较，在T1和T2时点，A组和B组CCA内径分别减少9．5％～12．9％和14．5％～24．3％（P〈0．05或P〈0．01），其中以B2组减少最为显著，A2组和B2组ICA内径分别减少10．9％和16．3％（P〈0．05）。CCA和ICA的血流速率无明显变化（P〉0．05）。与T0比较，A组和B组T1和T2时CCA的血流量分别减少9．3％～10．7％和12．2％～19．1％（P〈0．05），其中以B2组减少最为显著，A组和B组ICA血流量分别减少10．0％～13．5％和13．9％～16．6％（P〈0．05）。在L时点各观察指标均恢复至L水平。结论喉罩通气时，CCA和ICA的内径有所缩小，其血流量相应减少，老年患者减少更为明显，而其血流速率则无明显改变。

Objective To study the effects of laryngeal mask airway （LMA） on the hemodynanfics such as inner diameter , blood flow rate and volume of blood flow, etc of common carotid artery （ CCA ） and internal carotid artery（ICA） . Methods Sixty patients,aged 20-85y, weight 50-75 kg,with ASA grade Ⅰ - Ⅲ, undergone selective operation of laparoscopic cholecystectomy, were randomly allocated into two groups according to age： group A（20-59 y） and group B（60-85 y）. Group A and group B were divided into A1 and B1 （cuff pressure： 20-30 cm H20） （1 cm H2O =0. 098 kPa） , A2 and B2 （cuff pressure： 40-50 cm H20） respectively according to cuff pressure of 15 patients each. All the patients were given tracheal intubation and general anesthesia in operation. After the operation, patients were resuscitated in the Intensive Care Unit. Then the endotracheal catheter was pulled out and LMA was inserted. Hemodynamies such as inner diameter, blood flow rate and volume of blood flow, etc of CCA and ICA , and vital sign were recorded before LMA insertion （ T0 ） and at 3 rain （ Tl ） , 10 rain （ T2 ） after insertion, and after pulling out （ T3 ）. Results The base points of inner diameter and volume of blood flow of CCA and ICA in group B were greater than those in group A（P 〈0.05）. At T1 and T2 time points, the inner diameter of CCA of group A and group B decreased by 9.5%-12.9% and 14. 5%-24. 3% respectively compared to TO （ P 〈 0. 05 or P 〈 0. 01 ）. Group B2 decreased significantly among groups. The inner diameter of ICA of group A2 and group B2 decreased by 10. 9% and 16.3% respectively （ P 〈 0.05 ）. The blood flow rate of CCA and ICA changed little （ P 〉 0. 05）. The volume of blood flow of CCA of group A and group B decreased by 9.3% -10.7% and 12.2% - 19.1% respectively compared to To （ P 〈 0.05 ）. Group B2 decreased significantly among groups. The volume of blood flow of ICA of group A and group B decreased by 10.0% -13.5% and 13.9% -16.6% （ P 〈 0.05 ） respectively. At T3 time point, the above indexes returned to To level. Conclutions The volume of blood flow and inner diameter of CCA and ICA deerease a little when using LMA, which decrease significantly in old patients, but blood flow rate changes little.