ProSeal喉罩对老年乳腺癌根治术患者全身麻醉苏醒期的影响

Effect of ProSeal laryngeal mask airway on analepsia period of elder patients undergoing radical mastectomy

目的 比较ProSeal喉罩和气管导管在全身麻醉（全麻）苏醒期对老年乳腺癌根治术患者的影响.方法 美国麻醉医师学会（ASA）分级Ⅰ-Ⅱ级、择期在全麻下行乳腺癌根治术的老年女性患者30例,随机分为2组,ProSeal喉罩组（喉罩组,15例）与气管导管组（导管组,15例）.全麻后喉罩组放置ProSeal喉罩,导管组为气管插管.记录两组患者入室后5min（T0）、手术结束（T1）、呼唤睁眼（T2）、拔除导管或喉罩后即刻（T3）、拔除导管或喉罩后3min（T4）时的心率、收缩压、舒张压;记录全麻苏醒期使用降压药的例数,呛咳、烦躁及拔除导管或喉罩后咽痛、恶心、呕吐发生率.结果 喉罩组在T2点血压、心率[（140.2±8.7）mm Hg、（77.1±7.4）次/min]仅轻度增高,与T0[（134.8±12.6）mm Hg、（71.5±8.8）次/min]比较差异无统计学意义（P＞0.05）;但在T3点血压、心率[（143.3±8.5）mm Hg、（81.7±6.8）次/min]升高与T0比较差异有统计学意义（P＜0.05）.导管组在T2和T3时点,血压、心率[（146.5±13.5）mm Hg、（85.7±6.6）次/min和（151.4±11.7）mm Hg、（95.3±6.8）次/min]较T0[（132.1±12.1）mm Hg、（70.3±8.0）次/min]均明显增加（P＜0.05）,在T3点达最高峰.在T2、T3时点,喉罩组的血压、心率增加程度明显小于导管组（P＜0.05）.喉罩组患者苏醒时使用降压药、呛咳、咽痛的例数明显少于导管组（P＜0.05）;而拔管后烦躁、恶心、呕吐等并发症发生率,两组差异无统计学意义（P＞0.05）.结论 老年乳腺癌根治术患者使用ProSeal喉罩,明显减少麻醉苏醒期并发症的发生,有利于老年患者的麻醉安全.

Objective To explore the effect of ProSeal laryngeal mask airway and endotracheal tube on analepsia stage of general anesthesia in geriatric patients undergoing radical mastectomy.Methods Thirty geriatric females with breast cancer of American Standards Association （ASA）Ⅰ-Ⅱscheduled for selective radical mastectomy under general anesthesia were randomly allocated to two groups： ProSeal laryngeal mask airway group（PLMA group, n=15） and endotracheal tube group （ET group, n=15）. The patients were put on PLMA or were intubated with ET under general anesthesia in the two groups, respectively. The heart rate （HR）, systolic blood pressure（SBP）and diastolic blood pressure （DBP） were recorded at the time points of 5 min after entering operation room （T0）, end of surgery （T1）, opening eyes （T2）, after extubation （PLMA） immediately （T3） and 3 min after extubation （PLMA） （T4）. The numbers of patients who were given antihypertensive agent,showed bucking, agitation or sore throat, nausea and vomiting after extubation were recorded during the analepsia stage of general anesthesia. Results The blood pressure （BP） and HR were mildly.increased in PLMA group at T2, and there was no significant difference compared with T0（P＞0.05）. But the BP and HR were significantly higher at T3 than at T0 （P＜0.05）. In ET group, the BP and HR were both significantly elevated at T2 and T3 than at T0 （P＜0.05）, and reached the peak at T3. The increased levels of BP and HR were significantly lower in PLMA group than in ET group at T2 and T3 （P＜0.05）. The quantities of patients who were given antihypertensive agent, showed bucking and sore throat were less in PLMA group than in ET group（P＜0.05）. No differences in incidence rate of agitation, nausea and vomiting after extubation between the two groups were observed（P＞0.05）. Conclusions PLMA can obviously reduce the occurrence of complications in analepsia stage of general anesthesia in geriatric patients scheduled for selective radical mastectomy,and is beneficial to provide much safer anesthesia.