第三代喉罩对老年患者人工髋关节置换手术应激反应的影响

Clinical application of LMA ProSealTM in total hip arthroplasty on aged patients under general anesthesia

目的探讨第三代喉罩与气管插管对老年患者行人工髋关节置换手术围术期应激反应的影响。方法择期行人工髋关节置换手术的老年患者60例,随机均分成第三代喉罩插管组(P组,n=30)和气管导管插管组(T组,n=30),两组均行静吸复合麻醉,观察记录两组在麻醉诱导前、插管后1min、插管后5min、拔管前、拔管后5min各个时点的心率(HR)、心率与收缩压乘积(RPP)、血糖、皮质醇、拔管时呛咳发生率等指标。结果 T组在插管后1min、插管后5min、拔管后5min的HR、RPP明显高于P组(P<0.05),两组血糖自插管后均不同程度的上升,T组于插管后上升更明显,与P组比较差异有统计学意义(P<0.05);两组术毕时皮质醇水平均明显上升(P<0.05),T组拔管后继续上升;P组拔管时呛咳发生率低,与T组比较差异有统计学意义(P<0.05)。结论第三代喉罩插管应用于老年患者人工髋关节置换手术应激反应轻,心肌耗氧少,血流动力学稳定,具有临床推广应用价值。

Objective To evaluate the effect of LMA ProSealTM on stress reaction of the aged patients undergoing total hip arthroplasty.Methods 60 aged patients undergoing total hip arthroplasty under general anesthesia,with ASA gradeⅠtoⅡ,were randomly divided into two groups,the LMA ProSealTM group（P group,n=30） and endotracheal intubation group（T group,n=30）.Data of heart rate（HR）,HR×pressure product（RPP）,serum glucose and hydrocortisone were recorded at five different stages,before anaesthesia 1 minutes and 5 minutes,after intubation,before extubation,5 minutes after extubation.Results HR and RPP of patients in group T were significantly higher than that of patients in group P at the time points of 1 minutes and 5 minutes after intubation,5 minutes after extubation.Serum glucose of the two groups rose at different levels after intubation.Hydrocortisone of the two groups at the end of operation increased and had significant differences.The bucking frequency of group P was significantly lower than that of group T（P〈0.05）.Conclusions The application of LMA ProSealTM in elderly patients with total hip arthroplasty surgery can provide the benefit to the patient with light stress reaction,less myocardial oxygen consumption and stable hemodynamics.