喉罩小潮气量较快频率间歇正压通气在胸腔镜手汗症手术中的应用

Application of High-frequency Low-tidal Volume Intermittent Positive Pressure Ventilation with Laryngeal Mask in Thoracoscopic Surgery for Palmar Hyperhidrosis

目的评估喉罩小潮气量较快频率间歇正压通气在胸腔镜手汗症手术麻醉中应用的可行性和安全性。方法拟行胸腔镜下胸交感神经切断术的手汗症患者50例,随机分为两组(n=25):D组(双腔管组)行单肺通气;L组(喉罩组)行小潮气量较快频率间歇正压通气;术中持续监测呼气末二氧化碳(PetCO2)、血氧饱和度(SpO2)、平均动脉压(MAP)、心率(HR)、心电图(ECG)和双手温度。分别于麻醉诱导前(T1)、喉罩/双腔管置入前(T2)、喉罩/双腔管置入后1 m in(T3)、右胸切皮即刻(T4)、切断右胸交感神经即刻(T5)、右侧入镜孔缝合完成(T6)、切断左胸交感神经即刻(T7)、左侧入镜孔缝合完成(T8)、苏醒后拨喉罩/双腔管即刻(T9)各时点采集动脉血样进行血气分析,记录PetCO2、SpO2、MAP、HR等指标。同时记录喉罩/双腔管置入时间、麻醉时间、术中术后不良反应和并发症以及麻醉药的用量。结果 L组置入时间和麻醉时间明显少于D组(P<0.05);L组异丙酚、舒芬太尼的用量明显少于D组(P<0.05),两组麻醉手术均顺利,未发生呕吐、反流、误吸,术后无声音嘶哑。拔喉罩/双腔管呛咳、术后咽喉疼痛发生率L组明显低于D组(P<0.05)。D组MAP、HR水平在T3和T9时明显高于T1和T2时(P<0.05),D组MAP、HR水平在T3和T9时亦明显高于L组(P<0.05)。胸腔镜操作期间两组T5和T7时的二氧化碳分压(PaCO2)升高(P<0.05)。结论喉罩小潮气量较快频率间歇正压通气适用于胸腔镜手汗症手术的麻醉。

Objective To evaluate the feasibility and safety of high-frequency low-tidal volume intermittent positive pressure ventilation with laryngeal mask in thoracoscopic surgery for palmar hyperhidrosis.Methods Fifty palmar hyperhidrosis patients were randomly divided into two groups（n =25） before endoscopic thoracic sympathectomy：group D underwent single-lung ventilation through double-lumen tube,while group L underwent small-tidal volume high-frequency intermittent positive pressure ventilation through laryngeal mask（LMA）.Continuous monitoring of end-tidal carbon dioxide（PetCO2）,SpO2,mean arterial pressure（MAP）,heart rate（HR）,ECG and hand temperature perioperatively.Blood samples were collected for blood gas analysis at the following time points：before induction of anesthesia（T1）,before LMA/double-lumen tube placement（T2）,1 minute after LMA/double-lumen tube placement（T3）,the moment of incision in the right chest（T4）,the moment of cutting off the right thoracic sympathetic nerve（T5）,after suture of the right incision（T6）,the moment of cutting off the left thoracic sympathetic nerve（T7）,after the suture of the left incision（T8）,removal of laryngeal mask / double-lumen tube（T9）;PetCO2,SpO2,mean arterial pressure（MAP）,and heart rate（HR） were also recorded.Intubation time of LMA / double-lumen tube,length of anesthesia time,perioperative and postoperative complications and side effects,and dosage of anesthetics were also recorded.Results Intubation time and length of anesthesia time were significantly shorter in group L than in group D（P〈0.05）.Dosages of propofol and sufentanil were significantly lower in group L than in group D（P 0.05）.The anesthesia process and the surgery were successful in both groups,with no vomiting,regurgitation,aspiration,and postoperative hoarseness observed.Compared with the group D,incidence rates of post-extubation cough and postoperative sore throat were significantly lower in group L（P〈0.05）.MAP and HR levels at T3,and T9 were significantly higher than at T1 and T2 in group D than in group L（P〈0.05）,and were significantly higher than T3,and T9 than in group L（P〈0.05）.PaCO2 increased in both groups during the thoracoscopic operation at T5 and T7（P〈0.05）.Conclusion High-frequency low-tidal volume intermittent positive pressure ventilation with laryngeal mask is applicable to anesthesia in thoracoscopic surgery for palmar hyperhidrosis.