喉罩通气全身麻醉辅助臂丛神经阻滞在上肢手术中的应用

The advantages of laryngeal mask airway inspiration anesthesia combined with brachiai plexus blockage in upper limb orthopaedic surgeries

目的 探讨喉罩通气全身麻醉辅助臂丛神经阻滞在上肢手术中的应用.方法 择期行上肢骨折手术患者30例,完全随机分为2组,各15例：喉罩通气全麻辅助臂丛神经阻滞组（A组）和单纯喉罩通气全麻组（B组）.A组先予1.6%利多卡因20～25 ml注入患侧肌间沟行臂丛神经阻滞.2组皆以芬太尼1μg/kg、异丙酚2.5 mg/kg诱导后置入喉罩.术中根据患者自主呼吸频率、心率和无创血压以及体动反应调整异氟醚吸人浓度.观察入室（T0）、诱导前（T1）、喉罩置入后3 min（T2）、切皮后1 min（T3）各时点心率、血压、血氧饱和度（SpO2）变化.比较术中潮气量、呼吸频率、呼气末二氧化碳分压（PETCO2）、异氟醚呼气末浓度（ET）、异氟醚最低肺泡有效浓度（MAC）及维持芬太尼用量.记录术后疼痛程度.结果 T2和T3时点A组潮气量[（443.83±52.98）和（450.25±53.92）ml]明显高于B组[（219.00±53.24）和（301.44±60.48）ml,均P＜0.01].T3时点A组呼吸频率值[（12.00±0.74）次/min]明显低于B组[（15.11±3.76）次/min,P＜0.01],A组PETCO2[（41.5±4.34）mm Hg]低于B组[（46.22±5.73）mm Hg（P＜0.05）].T2时点A组异氟醚ET[（1.04±0.37）%]和异氟醚MAC[（0.97±0.33）%]显著低于B组（1.53±0.21）%和（1.44±0.14）%（P＜0.01）.T3时点A组异氟醚ET[（1.12±0.24）%]和异氟醚MAC[（0.98±0.21）%]低于B组[（1.29±0.15）%和（1.13±0.12）%,P＜0.05].A组术后镇痛优于B组（P＜0.01）.B组拔罩时有3例躁动、1例反流.结论 喉罩通气全麻辅助臂丛神经阻滞在上肢手术麻醉中能有效降低术中吸入麻醉剂浓度,减少术后并发症发生.

Objective To evaluate the advantage of laryngeal mask airway（LMA） inspiration anesthesia combined with brachial plexus blockage （BPB） in upper limb orthopaedic surgeries. Methods Thirty patients were divided randomly into two groups （n = 15）. In group A,LMA combined with BPB was adopted,while LMA was used only in group B. In group A,a dosage of 20-25 ml 1.6% lydocaine was adopted in BPB before indution. Then LMA was inserted by 1 μg/kg fentanyl and 2.5 mg/kg propofol. Isoflurane inhaled concentration and fentanyl dose was adjusted according to the change of spontaneous respiratory rate （RR）,heart rate （HR）,noninvasive blood pressure （SBP,DBP）and moving. The changes of HR,SBP,DBP and pulse blood oxygen saturation（SpO2） were observed at four time points when patients went into the operation room（T0）,before induction（T1）,3 minutes after LMA insertion（T2） and 1 minute after skin incision（T3）. Ttide volume（TV）,RR,end-tidal carbon dioxide（PET CO2）,expiratory concentration（ET） of isoflurane,minimum alveolar concentration（MAC） of isoflurane and fentanyl dose were compared between two groups. The ache degree was recorded after operations. Results At T2 and T3,TV in group A was higher than that in group B（P 〈 0.01）. At T3,RR in group A （12 ± 0.74） bpm was apparently lower than that in group B （15.11 ± 3.76） bpm （P 〈 0.01）. PET CO2 in group A （41.5 ± 4.34） mm Hg was lower than that in group B（46.22 ±5.73）mm Hg（P〈0.05）. At T2,ET of isoflurane（1.04 ±0.37）% and MAC of isoflurane（0.97 ±0.33）% in group A were significantly lower than ET of isoflurane（1.53 ±0.21）% and MAC of isoflurane（1.44 ± 0.14）% in group B（P 〈 0.01）. At T3,ET of isoflurane（1.12 ± 0.24） % and MAC of isoflurane （0.98 ± 0.21） % in group A were lower than ET of isoflurane （1.29 ± 0.15）% and MAC of isoflurane（1.13 ±0.12）% in group B （P 〈 0.05）. Conclusion LMA combined with BPB can effectively degrade the anesthetic gases inhalation consistency during operations and reduce the incidence rate of postoperative complications.