熵指数监测短小手术保留自主呼吸非气管插管全麻的气道管理

Minor Surgery with Different Airway Managements during Spontaneous Ventilation under Entropy-Guided Non-Intracheal Intubation Total Intravenous Anesthesia

目的:用熵指数监测麻醉深度,评价短小手术保留自主呼吸非气管插管全麻时不同气道管理方法对患者呼吸功能的影响。方法:60例在保留自主呼吸非气管插管全凭静脉麻醉下行单侧乳腺良性肿瘤切除术的患者,随机分为3组:单纯面罩吸氧组(组Ⅰ);口咽通气道加面罩吸氧组(组Ⅱ);喉罩(LMA)通气组(组Ⅲ)。术中维持熵指数40～60,分别在麻醉前(T0)、麻醉诱导后(T1)、手术开始(T2)、手术开始后5min(T3)、手术开始后10min(T4)、手术开始后15min(T5)、手术结束(T6)及术后30min(T7)时行动脉血气分析,同时观察比较呼气末二氧化碳分压(PetCO2)、血压、心率和脉搏氧饱和度。结果:组Ⅰ中需要辅助通气的患者显著多于其他2组。与T0相比,3组T1～T6时PetCO2和动脉二氧化碳分压(PaCO2)显著升高,T2～T6时组Ⅰ的PetCO2和PaCO2显著高于组Ⅱ和组Ⅲ。与T0相比,3组T2～T5时PH显著降低,T6时组Ⅰ的PH显著低于组Ⅱ和组Ⅲ。T1～T6时组Ⅲ的动脉氧分压显著高于组Ⅰ和组Ⅱ。结论:短小手术保留自主呼吸非气管插管全麻时存在发生急性高碳酸血症的可能。LMA是更有效的气道管理方法。

Objective：To evaluate the effects of different airway managements during spontaneous ventilation on respiratory functions in the patients under entropy-guided total intravenous anesthesia（TIVA）.Methods：Sixty patients scheduled to undergo benign breast tumor surgery were randomly assigned to Group Ⅰ（face mask）,Group Ⅱ（oropharyngeal airway and face mask） or Group Ⅲ（laryngeal mask airway）.All patients,with entropy values maintained between 40 and 60,were allowed to breathe spontaneously during the operation.The arterial blood gas analysis was performed at the following time points：preoperation（T0）,after the induction of anesthesia（T1）,at the skin incision（T2）,5 min after the skin incision（T3）,10 min after the skin incision（T4）,15 min after the skin incision（T5）,at the end of surgery（T6） and 30 min after the end of surgery（T7）.The blood pressure,heart rate,pulse oximetry and end-tidal CO2（PetCO2） were also recorded.Results：Significantly more patients in Group Ⅰneeded manually-assisted ventilation.PetCO2 and PaCO2 values of Group Ⅰ were significantly higher than those of the other two groups from T2 to T6.PH values decreased from T2 in three groups and returned to the normal level at T6 in Group Ⅱ and Group Ⅲ,which were significantly higher than those of Group Ⅰ.PaO2 values of Group Ⅲ were significantly higher than Group Ⅰ and Group Ⅱ from T1 to T6.Conclusions：Patients under TIVA with spontaneous ventilation could suffer from hypercapnia.Laryngeal mask may be a better choice for their airway management.