喉罩全麻对甲状腺手术血流动力学的影响

Effect of laryngeal mask airway for general anesthesia on the hemodynamics during thyroidectomy

目的观察喉罩全麻应用于甲状腺手术对血流动力学的影响。方法 50例择期行甲状腺手术的患者随机分成两组,气管插管组(Ⅰ组)和喉罩组(Ⅱ组),每组25例。Ⅰ组用喉镜明视法插入气管导管,Ⅱ组盲探或经喉镜插入喉罩。记录麻醉诱导前(T0)、诱导后(T1)、气管插管或喉罩置入后1min(T2)、拔除气管导管或喉罩前(T3)、拔除气管导管或喉罩后1min(T4),各时间点的平均动脉压(MAP)、心率(HR)值。术后2d随访患者,记录咽痛、声音嘶哑的发生率。结果Ⅰ组T2时点比T1时点、T4时点比T3时点MAP和HR均升高(P<0.05)。而Ⅱ组T2时点与T1时点、T4时点与T3时点MAP和HR比较差异无统计学意义(P>0.05)。Ⅰ组在T2、T3、T4时点的MAP高于Ⅱ组(P<0.05),在T2、T4时点HR高于Ⅱ组(P<0.05)。术后Ⅱ组咽痛、声音嘶哑发生例数少于Ⅰ组。结论喉罩通气全身麻醉对血流动力学影响小,术后咽痛、声音嘶哑发生率少,适合于甲状腺手术的麻醉。

Objective To study the effect of laryngeal mask airway for general anesthesia on the hemodynamics during thyroidectomy.Methods 50 patients who underwent thyroidectomy were randomly divided into 2 groups,tracheal intubation group（groupⅠ） and laryngeal mask group（group Ⅱ）,with 25 patients in each group.GroupⅠ were inserted tracheal intubation by laryngoscopy and group Ⅱ were inserted laryngeal mask by blind or laryngoscopy.Recorded the value of MAP and HR at the time before induction of anesthesia（T0）,after induction of anesthesia（T1）,and after intubation or LMA 1 minutes（T2）,and before extubate intubation or LMA（T3）,after extubate intubation or LMA 1 minutes（T4）.Patients were followed up 2 days later and recorded the incidence of sore throat and hoarse voice.Results The blood pressure（MAP） and heart rate at T2 time point in groupⅠwere higher than that at T1 time point,and T4 time point in groupⅠwere higher than that at T3 time point（P0.05）.The blood pressure（MAP） and heart rate at T2 time point and T1 time point showed no significant difference in group Ⅱ.The blood pressure（MAP） and heart rate at T4,T3 time point also were not significant difference in group Ⅱ.The value of MAP were higher at T2,T3,T4 time point in groupⅠthan those in group Ⅱ（P0.05）.The value of heart rate were higher at T2,T4 time point in groupⅠthan those in group Ⅱ（P0.05）.The morbidity rate of sore throat and hoarseness of groupⅠafter operation was obviously higher than that of group Ⅱ（P0.05）.Conclusion LMA was suitable for thyroidectomy with less hemodynamic changes,less morbidity rate of sore throat and hoarse voice after operation.