手术室外精神发育迟滞患者外周血单个核细胞移植术的麻醉管理

Anesthetic management of patients with mental retardation during autologous transplantation of peripheral blood mononuclear cells outside the operating room

目的本研究旨在探讨中、重度精神发育迟滞患者在手术室外进行外周血单个核细胞移植术时,对气道采用不同管理方法的全麻效果比较。方法选择拟进行外周血单个核细胞移植术的神经外科中、重度精神发育迟滞患者30人,采用全身麻醉,根据对患者气道管理方式不同,随机分为3组:不插管静脉麻醉组(MAC组,10例,保留患者自主呼吸,静脉应用丙泊酚麻醉),喉罩置入组(LMA组,10例,常规全麻诱导,置入喉罩)和气管内插管组(ETT组,10例,常规全麻诱导,气管内插管)。记录3组患者在手术过程中的心率、血压、脉搏血氧饱和度、治疗操作时间、患者苏醒时间、体动呛咳等不良反应,及麻醉后5min、1h、麻醉结束时和结束后1h的动脉血气分析。结果⑥MAC组与LMA、ETT组相比:丙泊酚用量[g/(kg·min)]有显著差异(分别为66.07±5.41;35.83±5.80;34.61±3.68,P<0.05);患者发生体动、呛咳反应次数(次)有显著差异(9.90±3.07;2.51±1.50;0.82±0.93,P<0.05);苏醒时间(min)有显著差异(16.82±7.60;4.31±1.32;3.73±1.33,P<0.05);⑥血气分析结果:3组患者麻醉后5min和结束后1h的PH、PaCO2、HCO3-无显著差异;MAC组麻醉后1h及麻醉结束前的血气分析结果与其他两组相比较,PH降低,PaCO2升高,且具有统计学显著差异(P<0.05)。结论对于手术室外精神发育迟滞患者的麻醉应用气管内插管全麻,与不插管镇静组和喉罩置入组相比,循环更加稳定,体动反应明显减少,苏醒更加完善,是更安全的手术室外麻醉方法。

Objective To observe the anesthetic effect and safety of differential airway management in patients with mental retardation（MR） during autologous peripheral blood mononuclear cell transplantation（APBMCT） outside the operating room.Methods In this prospective study,30 uncooperative patients with MR receiving total intravenous anesthesia（TIVA） with propofol for APBMCT were randomized into 3 groups with monitored anesthesia care（MAC group）,inserted classic laryngeal mask airway under general anesthesia（LMA group）,or endotracheal tube placement（ETT group）.The blood pressure（BP）,heart rate（HR）,SpO 2 and pH,PaCO 2 ,and HCO 3were monitored at 5 min and 1 h after anesthesia,before completion of the operation and at 1 h after the operation.The total operative time,dosage of propofol,awake time and body movement during the procedure were recorded.Results Compared with LMA and ETT groups,the MAC groups showed a significantly increased total dosage of propofol（66.07±5.41,35.83±5.80,and 34.61±3.68 g · kg-1 · min-1 ,respectively,P〈0.05 ）,body movements（9.90±3.07,2.5 1±1.50,and 0.82±0.93,P〈 0.05） and awake time（16.82±7.60,4.31±1.32,and 3.73±1.33 min,P〈0.05）.The pH,PaCO 2 ,or HCO 3showed no marked changes at 5 min after anesthesia and at 1 h after the operation in the 3 groups（P〉0.05）.At 1 h after anesthesia,the pH in MAC group decreased markedly compared with that in LMA and ETT groups（P〈0.05）,and maintained a low level till the completion of the operation;the PaCO 2 was significantly elevated in MAC group and remained so till the end of the surgery（P〈0.05）.Conclusion Endotracheal tube placement is safer than laryngeal mask airway placement and monitored anesthesia care in patients with MR during APBMCT,and allows rapid onset of sedation with minimal cardiovascular responses,body movement and recovery,therefore is more suitable in the setting outside the operating room.