异丙酚-七氟醚-芬太尼复合喉罩麻醉在老年患者经尿道激光膀胱肿瘤切除术中的应用

Use of Sevoflurane-Propofol-Fengtanyl Anesthesia with Laryngeal Mask Airway in Elderly Patients for Transurethral Laser Resection of Bladder Tumors

目的:评价异丙酚-七氟醚-芬太尼复合喉罩麻醉应用于老年患者经尿道激光膀胱肿瘤切除术(TLRBT)的效果及可行性。方法:选择ASAⅡ~Ⅳ级、择期行TLRBT的老年患者87例。七氟醚-异丙酚诱导,七氟醚-芬太尼麻醉维持。观察麻醉诱导、苏醒质量,喉罩插入条件,呼吸及血流动力学变化。记录术后疼痛视觉模拟评分(VAS)及不良反应。结果:成功率为93.1%。喉罩置入后呼吸暂停的发生率为13.8%,持续时间为(29±31)s。插入喉罩前平均动脉压(MAP)、心率(HR)与诱导前相比均显著下降(P<0.05),而喉罩插入后1min、2min、3min、手术开始时、手术开始后15min及喉罩拔出后1min、20min的MAP、HR与诱导前相比则无显著性差异(P>0.05)。麻醉苏醒时间为(9±4)min,19.5%患者术后恶心呕吐,14.6%患者术后咽痛,96%患者的VAS为0~1。结论:异丙酚-七氟醚-芬太尼复合喉罩麻醉诱导苏醒迅速,并且能够维持呼吸、循环稳定,可安全有效地应用于老年患者TLRBT中。

Objective： To evaluate the efficacy and feasibility of Sevoflurane-Propofol-fengtanyl anesthesia with laryngeal mask airway（LMA） in elderly patients for transurethral laser resection of bladder tumors（TLRBT）. Methods： Eighty-seven unpremedicated ASA physical status Ⅱ-Ⅲ patients, aged from 65 to 93, received anesthesia induction with sevoflurane 8 using the tidal volume breath technique supplemented with IV propofol lmg/kg, following maintenance with sevoflurane and low-dose fentanyl. The quality of induction, recovery, respiratory and hemodynamic changes and the incidence of postoperative side effects were observed. Results： Time to loss of eyelash reflex, induction time, incidence of successful insertion of LMA at the first attempt, incidence of apnea, apnea duration and recovery time were （45＋9）s,（117＋ 15）s, 93. 1%, 13.8%, （29＋31）s and（9 ＋ 4） min, respectively. Compared with baseline （ before induction）, mean arterial blood pressure （MAP） and heart rate （HR） decreased significantly before LMA insertion（P^0.05）, but the decrement extent was still within normal range. There were no significant changes of MAP, HR between lmin,2min,3min after LMA insertion, beginning of surgery, 15min after surgery and 1 min, 20min after IrMA extraction compared with baseline（P〉0.05）. The incidence of postoperative nausea and vom iting（PONV） and sore throat were 19.5% and 14.6% ,respectively. The visual analogue pain scale scores of 96% patients was 0-1 when leaving postanesthesia care unit. Conclusion： Sevoflurane propofol-fengtanyl anesthesia with LMA provides a smooth induction, maintenance and recovery with a stable cardiorespiratory profile in elderly patients for TLRBT, although associating with mild postoperative side effects such as PONV or sore throat.