欧普乐喉罩在预计困难插管患者中的临床应用

Application of oro-pharyngeal airway cap in patients with expected difficult intubation

目的比较研究丙泊酚靶控诱导(血浆靶浓度为6μg/m L)和七氟醚吸入诱导(8%的吸入浓度)下置入欧普乐喉罩在预计困难气管插管患者中应用的可行性与安全性。方法选择择期全身麻醉手术患者40例,男32例,女8例,ASA I、Ⅱ级,患者随机分成2组,每组20例,其中Ⅰ组为丙泊酚靶控诱导组,Ⅱ组为七氟醚吸入诱导组。观察并记录患者入室平静后(T1)、置喉罩前(T2)、置喉罩后即刻(T3)的M AP、H R和SpO 2等生理指标以及诱导时间、一次性置入成功率、置入喉罩所花时间、诱导时和置入后的各种相关并发症。结果丙泊酚组患者麻醉诱导后较诱导前M AP和H R均明显降低(P<0.05);丙泊酚组患者麻醉诱导后较七氟醚组患者麻醉诱导后M AP和H R均明显降低(P<0.05);两组各时点SpO 2比较差异无统计学意义(P>0.05);丙泊酚组患者的一次性置入成功率高于七氟醚组患者(P<0.001),诱导时间及置入时间均少于七氟醚组患者(P<0.001);失败率两组间无统计学差别(P>0.05);但丙泊酚组患者诱导时和置入时的呼吸暂停发生率均高于七氟醚组患者(P<0.05),且丙泊酚组有较高的注射痛发生率。结论保留自主呼吸的丙泊酚靶控诱导和七氟醚吸入诱导均能为困难气道处理提供较为安全和理想的欧普乐喉罩置入条件;丙泊酚组较七氟醚组能提供较快的诱导时间和较好的置入条件。

【Objective】 To observe the feasibility and the safety of oro-pharyngeal airway cap in patients with expected difficult intubation.【Methods】 Forty（ASA classⅠ or Ⅱ） patients,were randomly assigned to TCI of propofol induction group（group Ⅰ,n =20） and sevoflurane inhalation induction group（groupⅡ,n =20）.MAP,HR and SpO2 were recorded before anesthesia induction（T1）,before intubation（T2）,after intubation immediately（T3）;Induction time,one-time success rate of implantation,insertion time of OPLAC and various complications of after induction and placement were recorded.【Results】 In group Ⅰ,MAP and HR at T2 were significantly lower than those at T1;At T2,MAP and HR of group Ⅰ were significantly lower than those in group Ⅱ（P 0.05）;in all observed period,there is no SpO2 difference between the two groups（P 0.05）;in group Ⅰ,one-time success rate of implantation and induction time were significantly lower than those in group Ⅱ（P 0.001）;in group Ⅰ,the incidence of apnea of T2 and T3 were significantly higher than those in groupⅡ（P 0.05）.【Conclusion】 With spontaneous breathing target-controlled propofol induction and sevoflurane inhalation induction for the difficult airway management can provide a secure and ideal conditions for OPLAC;TCI of propofol induction group can provide faster induction time and better implantation conditions than sevoflurane inhalation induction group.