丙泊酚静脉麻醉与喉罩通气对支气管黏液运输速度的影响

Effect of laryngeal mask airway and propofol anesthesia on human bronchial mucus transport velocity

目的比较丙泊酚或七氟醚麻醉应用喉罩或气管插管机械通气时患者支气管黏液运输速度(BTV)的变化。方法 44例全身麻醉下机械通气患者随机均分为四组:喉罩+丙泊酚组(LP组),气管插管+丙泊酚组(TP组),喉罩+七氟醚组(LS组);气管插管+七氟醚组(TS组)。麻醉诱导用药相同,麻醉维持分别采用丙泊酚6～7mg·kg-1.h-1或七氟醚1.5%～2%联合雷米芬太尼0.1～0.2μg·kg-1.min-1。机械通气5、60min时,在纤维支气管镜引导下,用亚甲蓝在右支气管背段黏膜标记,通过测定亚甲蓝的移动速率计算BTV值。结果机械通气5min后,四组BTV值差异无统计学意义。机械通气60min后,TP、LS、TS组BTV值下降(P<0.01),LP组BTV值差异无统计学意义;组间比较,四组BTV值LP组>TP组>LS组>TS组(P<0.01)。结论丙泊酚静脉麻醉联合喉罩机械通气对呼吸道黏液纤毛传输功能的抑制作用最小。

Objective To compare the effect of propofol or sevoflurane combined with laryngeal mask airway （LMA） or endotracheal tube （ETT） on bronchial mucus transport velocity （BTV）in mechanical ventilated patients.Methods Forty-four patients scheduled for elective surgery were equally randomized into one of the four groups：LMA＋propofol （group LP）,ETT＋propofol （group TP）,LMA＋sevoflurane （group LS）,,and ETT＋sevoflurane （group TS）. Anesthesia was induced with the same anesthetics and was maintained with propofol 6-7 mg·kg-1·h-1 or sevoflurane 1.5%-2% in combination with remifentanil 0.1-0.2 μg·kg-1·min-1,respectively. BTV was calculated by assessing the movement of methylene blue applied to the dorsal surface of the right main bronchus under bronchofibroscope 5 and 60 min after mechanical ventilation.Results BTV had no significant difference 5 min after mechanical ventilation among the four groups. Sixty min after mechanical ventilation,BTV decreased in groups TP,LS and TS （P0.01）,and had no significant change in group LP. For group comparisons,BTV values were as the following sequence group LPgroup TPgroup LSgroup TS （P0.01）. Conclusion Propofol combined with LMA has less inhibition effect on BTV in mechanical ventilated patients