加强型喉罩与气管导管在鼻内窥镜手术中血流动力学和呼吸动力学比较

The comparison of hemodynamics and respiratory mechanics between flexible reinforced laryngeal mask airway and tracheal intubation in functional endoscopic sinus surgery

目的比较加强型喉罩和气管导管用于鼻内窥镜手术中对血流动力学及呼吸动力学的影响。方法拟在全身麻醉下择期行鼻内窥镜手术的患者46例(ASA)随机分为气管插管组(TI,n=23)和喉罩组(FRLMA,n=23)。麻醉诱导分别置入气管内导管或喉罩。记录诱导前、诱导后、插管后即刻、拔管前5min、拔管后即刻的平均动脉压(mean arterial pressure,MAP)、心率(heartrate,HR)和脉搏氧饱和度(SpO2);麻醉诱导后5、10、15min记录呼吸动力学指标:吸气峰压(PIP)、吸气平台压(Pplateau)、平均气道压(Pmean)、呼气末正压(PEEP)、吸气峰流速(FImax)、呼气峰流速(FEmax)、呼末二氧化碳分压(PEtCO2)和动脉血气;以及术后误吸、呛咳、咽部疼痛、声嘶、肌肉酸痛、喉罩不密封等指标。结果插管(喉罩)和拔管(喉罩)后TI组MAP,HR均高于LMA组,有统计学差异(P<0.05);TI组PIP、Pplateau、Pmean、VD/VT高于FRLMA组,有统计学差异(P<0.05);TI组咽痛、呛咳和肌肉酸痛发生率高于FRLMA组(P<0.05)。结论喉罩的应用较好地适应了鼻内窥镜手术的需要。其血流动学稳定,呼吸动力学平稳,不使用去极化肌松药,减少肌肉酸痛,有利于术后恢复;苏醒期血流动力学平稳,无明显呛咳,出血少;术后咽痛率低,舒适度提高。

Objective To compare the hemodynamics and respiratory mechanics between flexible reinforced laryngeal mask airway （FRLMA） and tracheal intubation （TI） in functional endoscopic sinus surgery. Methods Forty-six patients （ASA） scheduled for selective functional endoscopic sinus surgery under general anesthesia were allocated randomly to either flexible reinforced laryngeal mask airway group （FRLMA, n=23） or tracheal intubation group （TI, n=23） with mechanical ventilation. MAP and HR were recorded before anesthesia induction, before intubation, after intubation immediately, before extubation and after extubation immediately. Parameters for respiratory mechanics included peak inspiratory pressure （PIP）, plateau airway pressure （Pplateau）, mean airway pressure （Pmean）, positive end expiratory pressure （PEEP）, peak inspiratory flow （FImax）, peak expiratory flow （FEmax）, and end tidal CO2 （PEtCO2）. All of the above indicators were recorded 5, 10 and 15 minutes after intubation. Meanwhile, arterial gas analysis was examined. Complications such as aspiration, coughing, pharyngeal pain, hoarseness, muscular soreness and unseal of FRLMA were followed up 24 hours after extubation. Results MAP and HR were significantly higher in group TI than those in group FRLMA after intubation and extubation （P0.05）. PIP, Pplateau, Pmean and VD/VT were significantly higher in group TI than those in group FRLMA （P0.05）. Complications such as coughing, pharyngeal pain and muscular soreness were significantly lower in FRLMA group than that in TI group （P0.05）. Conclusions The application of FRLMA on functional endoscopic sinus surgery is a simply handling method, with minor laryngeal stimulation during intubation and extubation, more stable hemodynamics, reliable respiratory mechanics and low incidence of postoperative upper airway complications.