Proseal喉罩通气全麻在乳腺手术中的应用

The application of general anesthesia of Proseal laryngeal mask airway in breast surgery

目的:观察Proseal喉罩用于乳腺手术全麻的安全性、有效性和可行性。方法:60例ASAⅠ～Ⅱ级、择期行乳腺手术的患者,随机分为气管插管(TT)组和喉罩(LMA)组,每组30例。入室后开放下肢静脉,监测生命体征,麻醉诱导以力月西0.1mg/kg、芬太尼6μg/kg、阿曲库铵0.6mg/kg、丙泊酚1mg/kg,麻醉维持以丙泊酚4～6mg/(kg.h)、阿曲库铵8μg/(kg.min)、瑞芬太尼0.2μg/(kg.min)微量泵泵注。观察气管插管及置入喉罩前、即刻和苏醒拔管及拔罩时的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)、呼气末CO2分压值(PETCO2),记录拔管拔罩期及术后24h并发症。结果:TT组插管及拔管即刻的MAP、HR明显高于置管前,有显著性差异(P<0.05);LMA组置罩及拔罩即刻的MAP、HR略高于置罩前,无显著性差异(P>0.05);TT组插管及拔管即刻的MAP、HR明显高于LMA组置罩及拔罩即刻的MAP、HR,有显著性差异(P<0.05)。两组SPO2、PETCO2间无显著性差异(P>0.05)。拔管拔罩期血压升高、心率增快、恶心呕吐、呛咳、咽痛、声嘶发生率比较,LMA组明显低于TT组,有显著性差异(P<0.05);术后24h咳嗽、咳痰、咽痛、咽干情况比较,LMA组明显低于TT组,有显著性差异(P<0.05)。结论:Proseal喉罩能安全、有效地用于全麻下乳腺手术,能达到与气管插管相同的通气效果,并且喉罩能有效地减少应激反应及术后并发症的发生。

Objective：To observe the safety,effectiveness and feasibility of general anesthesia of Proseal laryngeal mask airway in breast surgery. Methods：60 patients （ASAⅠ-Ⅱ,scheduled for elective surgery） were randomly divided into tracheal intubation （TT） group and the laryngeal mask airway （LMA） group,30 cases in each group. After the open venous burglary,monitoring vital signs,anesthesia was induced with Midzolam 0.1 mg/kg,Fentanyl 6 μg/kg,Atracurium 0.6 mg/kg,Propofol 1 mg/kg,and was maintained a continuous infusion of Propofol 4-6 mg/（kg.h）,Remifentanil 0.2 μg/（kg.min）,A-tracurium 8 μg/（kg.min）. We observed the tracheal intubation and laryngeal mask airway insertion prior to extubation and the immediate and wake up when you pull hood mean arterial pressure （MAP）,heart rate （HR）,pulse oxygen saturation （SPO2）,end-tidal CO2 partial pressure value （PETCO2 ）; and recorded the extubation pull hood,the wake,the postoperative complication in 24 hours. Results：TT group immediate intubation and extubation MAP,HR was significantly higher than before the catheter,there was a significant difference（P〉0.05）; LMA group home cover and pull cover immediate MAP、HR slightly higher than the pre-set cover,there was no significant difference（P〈0.05）; TT group immediate intubation and ex-tubation MAP,HR were compared,there was significant difference （P〈0.05）. There was no significant difference between the SPO2、PETCO2 of two groups （P〈0.05）. Removing hood extubation period of high blood pressure,heart rate increased quickly,nausea and vomiting,cough,sore throat,hoarseness of LMA group was significantly lower than the incidence of TT group,there was significant difference（P〉0.05）; the situation of cough,sputum,sore throat at 24 hours after surgery were compared,LMA group was significantly lower than the TT group,there was significant difference（ P〈0.05）. Conclusion：Proseal laryngeal mask can be safely and effectively used for breast surgery under general anesthesia,can achieve the same ventilation and the effects of endotracheal intubation and laryngeal mask airway,can effectively reduce the stress response and the occurrence of postoperative levy.