喉罩通气技术对闭孔神经反射的预防作用

PREVENTION EFFECT OF LARYNGEAL MASK VENTILATION ON OBTURATOR NERVE REFLEX

目的通过观察喉罩技术加用肌肉松弛剂预防闭孔神经反射的临床效果,寻求经尿道电切术最佳麻醉方法。方法 86例膀胱肿瘤患者根据麻醉方式的不同被随机分为腰硬联合麻醉组(脊麻组)和喉罩复合肌松药全麻组(全麻组),每组43例。分别在麻醉前(T0)、麻醉平稳后10 min(T1)、膀胱电切时(T2)及手术结束时(T3)监测并记录血流动力学变化;记录术中闭孔神经反射的发生率;术后24 h随访有无腰痛、咽喉疼痛等不良反应。结果与T0比较,T1时脊麻组SBP下降(t=3.76p,<0.01),T2时SBP及HR升高(t=3.01及t=2.45p,<0.01),差异有显著性意义;全麻组各时段SBP及HR无显著性变化(p>0.05)。结论采用喉罩技术加用肌肉松弛剂,不仅麻醉过程平稳,而且能够预防闭孔神经反射,是经尿道电切术较为理想的麻醉方法。

Objective To observe the effect of laryngeal mask ventilation on obturator nerve reflex, investigate the best anesthesia approach of per urethra electroeision. Methods 86 patients with bladder neoplasms were randomly divided into spinal analgesia group and general analgesia group ,43 cases in each group. Hemodynamies was recorded before analgesia （ T0 ）, at 10 minutes after analgesia steady （ T1 ） , at electroeision （ T2 ） , and at the end of operation（ T3 ）. And incidence rate of obturator nerve reflex and adverse reaction such as low back pain and sore throat 24 hours after operation were recorded. Results Compared with that at TO, SBP in spinal analgesia group at T1 decreased （ t = 3.76 ,p 〈 0.01 ） , and SBP and HP at T2 increased significantly （ t = 3.01 and t = 2.45 ,p 〈 0.01 ）. SBP and HR in general analgesia group at different time had no difference markedly （p 〉 0.05 ）. Conclusion Laryngeal mask ventilation can prevent obturator nerve reflex,it is an ideal anesthesia approach for per urethra eleetroeision.