欧普乐喉罩在颅内动脉瘤患者数字减影血管造影诊断与栓塞术中的临床应用

Application of OPLAC laryngeal mask airway to digital subtraction angiography diagnosis and interventional therapy for intracranial aneurysm

目的探讨在颅内动脉瘤患者数字减影血管造影（DSA）诊断与电解可脱卸弹簧圈（GDC）栓塞术中采用欧普乐喉罩麻醉的有效性和安全性。方法择期行颅内动脉瘤DSA和GDC栓塞术患者60例，ASA分级I～Ⅲ级，随机分为气管导管组（T组）和欧普乐喉罩组（O组）。观察患者入介入室后10min（To）、插管前即刻（T1）、插管后即刻（T2）、插管后3min（T3）、拔管前即刻（T4）、拔管后3min（L）的心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（P书O：）和气道峰压，并于以上各时间点抽取静脉血检测肾上腺素（E）、去甲肾上腺素（NE）水平。记录手术时间、麻醉时间及拔管和术后并发症。结果T组T2、T3HR、MAP较R明显升高（P〈0．05），而O组升高不明显（P〉0．05）；O组在T2～T，时HR、MAP均明显低于T组（P〈0．05）。O组B～T5E和NE明显低于T组（P〈0．05），T3～T5 T组E和NE高于To（P〈0．05），O组差异无统计学意义（P〉O．05）。术毕O组安静拔管例数明显多于T组（25例比5例）（P〈0．01），而发生呛咳的例数明显少于T组（5例比24例）（P〈O．01）。结论欧普乐喉罩操作简单，插入与拔出时咽喉部刺激性小，诱导及苏醒过程中血流动力学平稳，循环干扰轻，通气可靠，可安全有效地应用于颅内动脉瘤DSA诊断与GDC栓塞术的麻醉中。

Objective To explore the validity and security of OPLAC laryngeal mask applying to GDC embolism for intracranial aneurysms following digital subtraction angiography （DSA）diagnosis. Methods Sixty patients with ASA Ⅰ -Ⅲ suffered from intracranial aneurysms following DSA and GDC embolism were randomly divided into 2 groups： tracheal catheter group （T group） and OPLAC laryngeal mask group （O group ）. The heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen saturation （SpO2）, breath powder carbon dioxide （PrrCO2） and airway peak voltage were observed in room after 10 minutes（T0）, intub immediately （T1）, intubed immediately （T2）, 3 min （T3）, extubated immediately（T4）, 3 min（Ts）. Took suction vein blood to detect adrenalin （E）, norepinephrine （NE） level at all above time. Recorded operation time, anesthetize time and extubate and postoperative complications. Results HR and MAP changed obviously at T2 and T3 compared those at To in T group（P〈 0.05）,but they were no obvious change in O group （P 〉 0.05 ）. HR and MAP were lower at T2 - T5 in O group than those in T group （P 〈 0.05 ）. E and NE were lower at T3 - T5 in O group than those in T group （P 〈 0.05 ）. E and NE were higher at T3 - T5 than those at To in T group （P 〈 0.05 ）. The cases of quiet extubated were more in O group than that in T group （25 cases vs 5 cases, P 〈 0.01 ）, the cases of bucking were less than that in T group （5 cases vs 24 cases, P 〈 0.01 ）. Conclusion OPLAC handles a simplicity, pharynx and larynx part pungency is minor time insertion and the extraction, blood flow mechanics is stable, the circulation disturbance makes light, but safe and effective applies to skull inner aneurism DSA to diagnose and get involved in embolism skill anesthesia middle in guidance and process.