吸入七氟烷用于老年患者放置喉罩通气道的临床观察

Clinical observation on inhalation induction with sevoflurane for insertion of laryngeal mask airway in elderly patients

目的比较七氟烷吸入诱导和丙}自酚静脉诱导用于老年患者插入喉罩通气道（LMA）的临床效能和安全性。方法40例ASAⅠ-Ⅱ级择期行全膝关节置换手术的老年患者随机分为两组。G1组麻醉诱导采用静脉靶控输注丙泊酚，效应室浓度4燃／ml；G2组以肺活量法吸入七氟烷，目标呼末浓度为3％。通过开口试验，判断插入LMA适宜时机。观察麻醉诱导和放置LMA的过程，记录期间患者血流动力学的变化和不良反应的发生情况。结果两种诱导方法都可以保证超过85％的患者一次顺利完成LMA的放置。尽管C2组患者意识消失时间较G1组延长了约39．1s，但两组患者适宜LMA插入的麻醉诱导时间相同。与G1组患者诱导后MAP明显下降不同，G2组患者试验期间血流动力学状态稳定，而且插入LMA后呼吸暂停的发生也明显低于G1组（20％与85％，P〈0．05）。结论七氟烷吸入诱导可替代丙泊酚静脉诱导用于老年患者放置LMA。

Objective To compare the clinical efficacy and safety of anesthesia induction between inhalation of sevoflurane and intravenous injection of propofol for laryngeal mask airway （LMA） insertion in elderly patients. Methods 40,ASA physical grade Ⅰ-Ⅱ patients scheduled to receive elective total knee arthroplasty were allocted to 2 groups at random. Patients in group one（ G1 ） received intravenous induction of propofol infusion by a target- controlled infusion system which was set at the effect-site concentration of 4.01a,g/ml ,while patients in group two（G2） received inhalational induction with sevoflurane using vital capacity manoeuver at the target of end-expiratory concen- tration of 3.0%. We observed the whole procedure of anesthesia induction and LMA insertion, while recording the changes in hemodynamic state and occurrence of adverse events. Results More than 85% patients achieved LMA in- sertion at first attempt using either induction manoeuver. Although consciousness loss time in G1 was 39. 1 s longer than G2 ,there was no difference in anesthesia induction time for LMA insertion between these two groups. Contrary to a significant decrease in MAP following induction for patients in G1, there appeared hemodynamically stable in patients of G2, while apnea also significantly seldom occurred in G2 as compared to G1 （ 20% vs 85%, P 〈 0.05 ）. Conclusion As compared to intrvenous induction with propofol,inhalation induction with sevoflurane provided a valuable alternative for LMA insertion in adults.