Classic^TM喉罩用于老年患者腰-硬联合阻滞术中镇静的临床效果

Clinical Research on the Application of ClassicTM Laryngeal Mask in Intraoperative Sedation of Elderly Patients Undergoing Epidural-spinal Anesthesia

【目的】评估Classic^TM喉罩用于老年患者腰-硬联合阻滞术中镇静的临床效果与可行性。【方法】选择在腰-硬联合阻滞下行下腹部或下肢手术的老年患者40例，年龄60～80岁，男22例，女18例，随机分为两组。两组患者蛛网膜下腔均给以0．5％布比卡因重比重混合液2．5mL。首次静脉注射丙泊酚1mg／kg后以10μg／（kg·min）速度持续泵注镇静。面罩组（M纽）使用密闭面罩吸氧；喉罩组（LMA组）使用Classic^TM喉罩连接麻醉机开放模式吸氧。监测并记录两组患者术前、术中呼吸，循环及动脉血气情况。【结果】LMA组术中脉搏血氧饱和度（SpO2）均值为（99．3±1．1%），出现SpO2〈95%者2例，而M组相应分别为（97．7±1．6）％，13例，两组比较差异有显著性（P〈0．05）。LMA组辅助通气次数以及术中舌后坠例数与M组差异有显著性（P〈0．05）。与M组比较术中LMA组的pH，动脉氧分压（PaO2），动脉二氧化碳分压（PaCO2）与M组差异有显著性（P〈0．05）。【结论】Classic^TM喉罩用于老年患者腰-硬联合阻滞下术中镇静，利于保持呼吸循环平稳，且安全可行。

[Objective] To evaluate the effect of ClassicTM laryngeal mask in intraoperative sedation of elderly patients undergoing epidural-spinal anesthesia. [Methods] Forty ASA Ⅱ-Ⅲ elderly patients（aged 60 -80 years old） undergoing selected bythus or lower extremity surgery were divided into 2 groups randomly. The 0.5% bupivacaine mixture 2. 5 mL with heavy specific gravity was injected into subaraehnoid space of both groups. Patients of facemask group （group M） inspired oxygen （3 L/min） through facemasks of anaesthesia apparatuses after propofol i mg/kg was injected and assisted with ventilation for lmin, and the continuous infusion rate of propofol was 10μg/（kg·min）. Patients of laryngeal mask group （group IRMA） were inserted with Classic laryngeal mask in digital technique after propofol 1 mg/kg was injected, and inspired oxygen （3 L/min） through laryngeal mask that connected anaesthesia apparatuses. Group LMA were assisted with ventilation for lmin, and the continuous infusion rate of propofol was 10μg/（kg · min） too. Respiration, circulation and arterial blood gas analysis of two groups were recorded and measured perioperatively. [Results] The mean intraoperative SpO2 in group LMA was（99.3±1.1%）, and 2 cases had SpO2 〈95 %. The mean intraoperative SpO2 in group M was （97. 7± 1. 6）%, and 13 cases had SpO2 〈95%. There was significant difference in the mean intraoperative SpO2 between two groups（ P 〈0.05）. There was also significant differ enee in the number of assisted ventilation and the incidence of intraoperative glossocomamean between group LMA and group, M（ P 〈0.05）. The difference in pH, PaO2 and PaCO2 between two groups had significance（ P 〈0.05）. [Conclusion] The Classic laryngeal mask airway for the intraoperative sedation of elderly patients undergoing epidural-spinal anesthesia is benefit for maintaining the stable respiration and circulation, and it is safe and feasible.