欧普乐喉罩与气管内插管在乳腺癌根治术病人全麻中的应用

Application of oro-pharyngeal airway cap laryngeal mask with endotracheal intubation in patients with breast cancer undergoing radical mastectomy

目的:观察欧普乐喉罩(OPLAC laryngeal mask)和气管内插管(ET)用于乳腺癌根治术对患者血流动力学和血浆儿茶酚胺的影响。方法:40例行择期乳腺癌根治术患者,术前情况评估为ASAⅠ-Ⅱ级,年龄35-52岁,体重48-67kg,随机分为OPLAC喉罩组(A组)和气管导管组(B组),每组20例。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)和拔管后即刻(T6)记录SBP、DBP、HR和SpO2。于T0、T2、T6时采集外周静脉血标本,应用高效液相色谱分析法测定血浆肾上腺素(AE)和去甲肾上腺素(NE)水平。结果:B组T2与T6时SBP、DBP和HR显著高于A组(P<0.05);AE和NE在T2、T6时均显著高于A组(P<0.05)。结论:应用OPLAC喉罩通气全凭静脉麻醉实施乳腺癌根治手术血流动力学稳定,无明显应激反应。

Objective：To study the effects of oro - pharyngeal airway cap laryngeal mask （OPLAC laryngeal mask） and endotracheal intubation （ET） on hemodynamics and plasma catecholamines in patients with breast cancer undergoing radical mastectomy. Methods ： Forty ASA Ⅰ or Ⅱ patients with breast cancer scheduled for selective radical mastectomy under general anesthesia were alocated randomly to either OPLAC laryngeal mask group （ group A） or ET group（ group B） with mechanial ventilation. SBP, DBP, HR and SpO2 were recorded before anesthesia induction （ T0 ）, before intubation （ T1 ）, after intubation immediately （ T2 ）, at 5 min （ T3 ）, 10 min （ T4 ）, 15min （ T5 ） after intubation, after extubation immediately（ T6 ）. Blood samples were taken at T0 ,T2 and T6 for the measurements of epinephrine（AE） and norepinephrine （NE） levels with high performance liquid chromatography. Results：In group B, SBP, DBP and HR were significantly higher than those in group A at T2 and T6 （P 〈 0.05）. AE and NE were also significantly higher in group B than those in group A at T2 and T6 （ P 〈 0.05 ）. Conclution： Hemodynamics were kept stable with less stress response during OPLAC laryngeal mask in total intravenous anesthesia for radical mastectomy.