双管喉罩通气七氟醚吸入全麻在乳腺手术中的应用

Application of ProSeal laryngeal mask combined with sevoflurane inhalation anesthesia in breast surgery

目的探讨食管引流型喉罩(LMA-ProSeal,PLMA)通气下静吸复合麻醉在乳腺手术中的应用效果。方法择期短小乳腺手术患者40例,随机均分为PLMA通气静吸复合麻醉(A)组和单纯静脉麻醉(B)组。常规监测平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、ECG,并于麻醉前、术毕抽取桡动脉血行血气分析,比较两组麻醉效果和不良反应。结果 A组术毕MAP、HR、SpO2、pH、PaCO2与麻醉前比无明显差异(P>0.05),PaO2比麻醉前明显升高(P<0.01)。B组术毕MAP、HR、SpO2与麻醉前比无明显差异(P>0.05);术毕B组PaCO2明显高于A组[(59.3±7.7)mm Hgvs.(39.4±4.9)mm Hg]、pH明显低于A组[(7.26±0.05)vs.(7.39±0.04)](P<0.01)。两组术后的不良反应相仿(P>0.05)。结论与不插管单纯静脉麻醉相比,PLMA通气下静吸复合麻醉便于气道管理,维持呼吸、循环稳定。

Objective To observe the clinical effect of sevotlurane inhalation anaesthesia with ProSeal laryngeal mask（PLMA） ventilation in patients undergoing breast operation.Methods Forty patients randomly divided into two groups with 20 cases each.Group A was anesthetized with sevoflurane inhalation under PLMA ventilation and those in group B with propofol-remifentanyl intravenous anestheasia.MAP,HR,ECG and SpO2 were monitored during anesthesia.The arterial blood gas analysis was performed before and at the end of operation.The side effects were recorded as well.Results Compared to before,MBP,HR,SpO2,pH and PaCO2 in group A were not significantly changed with increased PaO2.At the end of operation in group B,MBP,HR and SpO2 were similar to those before,but PaCO2 was higher and pH was lower,obviously than those before anesthesia and those in group A [（59.3±7.7） mmHg vs.（39.4±4.9）mmHg,（7.26±0.05） vs. （7.39±0.04）]（P0.01）.The side effects of group A were similar to those of group B.Conclusion Compared to conventional propofol-remifentanyl intravenous anestheasia,sevoflurane inhalation under PLMA ventilation is benificial to the management of airway and maintenance of respiration and circulation.