双管喉罩置入与气管插管在脑室腹腔分流手术麻醉中的应用比较

Comparison of laryngeal mask airway and endotreacheal intubation in ventriculoperitoneal shunt surgical anesthesia

目的比较PRO-SEAL LMA喉罩和气管插管用于脑室腹腔分流手术对患者呼吸循环和并发症的影响。方法 43例在全麻下实施脑室腹腔分流手术的患者,ASAⅡ～Ⅲ级,年龄23～67岁,随机被分为PRO-SEAL LMA喉罩组(LMA组)(n=22)和气管插管组(TT组)(n=21)。分别记录麻醉前(T1)、插入喉罩/气管导管后即刻(T2)、拔管前即刻(T3)、拔管后即刻(T4)患者的平均动脉压、心率、呼吸系统变化、麻醉深度指数及两组拔管期的不良反应和术后并发症。结果气管插管组T2、T3、T4时MAP和HR均显著高于喉罩组(P<0.01);PRO-SEAL LMA型喉罩组患者T3时潮气量、气道压、肺顺应性分别与气管插管组组间差异有显著性意义(P<0.01)。PRO-SEAL LMA喉罩组患者麻醉深度指数在T3、T4时与气管插管组间差异有显著性意义(P<0.01)。拔管期气管插管组发生体动、呛咳、术后咽喉痛、声音沙哑较PRO-SEAL LMA喉罩组明显增加,差异有统计学意义(P<0.01);两组发生套囊血迹的差异无统计学意义(P>0.05)。结论全麻条件下PRO-SEAL LMA喉罩通气用于脑室腹腔分流手术对患者呼吸循环的影响较小,可明显减少咽喉并发症,其效果优于气管插管,值得临床推广。

Aim To compare the effects of respiration and circulation and complications of PRO-SEAL LMA laryngeal mask and endotracheal intubation in patients with ventriculoperitoneal shunt surgery.Methods 43 patients,ASA II-Ⅲ,aged 23-67 years,who received surgery for ventriculoperitoneal shunt surgery under general anesthesia were randomly divided into PRO-SEAL LMA group（n=22）and tracheal intubation（TT）group（n=21）.MAP,HR,respiration system change and cerebral state index were recorded before induction of anesthesia（T_1）,immediately after intubation（T_2）,before extubation（T_3）,and immediately after extubation（T4）.Adverse reactions during extubation and the postsurgical complications were observed.Results MAP and HR were significantly higher in TT group than in LMA group at T_2,T_3,and T4（P0.01）.There were significant differences between LMA group and TT group in VT,PAW,and PCL at T_3（P0.01）.There were significant differences between LMA group and TT group in cerebral state index at T_3 and T_4（P0.01）.The incidence of body movement and coughing during extubation and that of postoperative gore throat and hoarse voice were higher in TT group than in LMA group（P0.01）.Conclusions Laryngeal mask airway is better than endotreacheal intubation in patients undergoing surgery for ventriculoperitoneal shunt.It is easier to maintain hemodynamic and respiration function stability and has fewer complications.