喉罩全麻在人工听骨植入术中的应用研究

Laryngeal Mask Airway on general anesthesia Used in Aartificial auditory ossicle implanting

目的观察喉罩全麻应用于人工听骨植入术中的安全性和优越性。方法 80例ASA I～Ⅱ级需要择期手术治疗的中耳炎患者,根据手术类型分为两组:喉罩通气组(L组;中耳成形+人工听骨植入术)和气管插管组(T组;单纯中耳成形术)。在麻醉前即刻(T0)、插管前即刻(T1)、插管后即刻(T2)、插管后3 min(T3)、拔管前即刻(T4)、拔管后即刻(T5)、拔管后3 min(T6)记录SBP、DBP和HR;比较两组拔管期的呛咳反应程度和麻醉恢复时间。结果喉罩组和气管插管组T1时SBP、DBP均显著低于T0时(P<0.05);气管插管组T2时HR及T5时SBP、DBP和HR较T0时显著升高(P<0.05);组间比较T2时气管插管组SBP、DBP和HR均显著高于喉罩组(P<0.05),T5时气管插管组SBP和HR显著高于喉罩组(P<0.05);拔管期T组呛咳发生率、自主呼吸恢复时间和拔管至清醒时间明显高于喉罩组(P<0.05)。结论喉罩全麻特别适用于人工听骨植入术的麻醉管理,易于维持血流动力学稳定,应激反应轻微,有效避免了拔管时呛咳引起的手术失败。

Objective To observe the safey and advantage when laryngeal mask（LAM） used in general anesthetic operation under artificial auditory ossicle implanting.Methods Eighty ASA I～II patients suffering from otitis media were divided into two groups：1aryngeal mask group（patients underwent tympanoplasty and the artificial auditory ossicle implanting,group L） and endotracheal intubation group（patients underwent tympanoplasty only,group T）.SBP,DBP and HR were recorded before anesthesia induction（T0）,before intubation（T1）,after intubation immediately（T2）,at 3 min after intubation（T3）,before extubation（T4）,after extubation immediately（T5）,at 3 min after extubation（T6）.Extubation were compared the extent of the cough reflex and anesthesia recovery time.Results During two groups,SBP and DBP of T1 were significantly less than those at T0（P〈0.05）;In group T,HR of T2 and SBP、DBP and HR of T5 were significantly higher than those at T0（P〈0.05）;In group T,SBP、DBP and HR were significantly higher than those in group L at T2（P〈0.05）.SBP and HR in group T were significantly higher than those in group L at T5（P〈0.05）.Extubation cough of T group the incidence of spontaneous breathing recovery time,and to awake extubation time was significantly higher than the LMA group（P〈0.05）.Conclusion Laryngeal mask anesthesia suitable for Management of Aartificial auditory ossicle implanting,Easy to maintain hemodynamic stability,mild stress response,Effectively avoiding surgery failure caused by Coughing.