不同麻醉深度下SLIPA^(TM)喉罩与气管内插管对应激反应影响的比较

Effects of inserting the SLIPATM laryngeal mask and tracheal tube on stress responses at different depths of anesthesia

目的探讨SLIPA^(TM)喉罩对应激反应的影响及最佳置入麻醉深度。方法择期全麻手术患者120例,随机分为6组,根据呼吸道管理方式和脑电双频指数(Bispectral Index,BIS)数值,依次分为:喉罩+BIS40组(A_1)、喉罩+BIS50组(A_2)、喉罩+BIS60组(A_3)、气管插管+BIS40组(B_1)、气管插管+BIS50组(B_2)、气管插管+BIS60组(B_3)。麻醉诱导时待麻醉深度(BIS)达到40、50、60时,分别置入SLIPA^(TM)喉罩或行气管内插管,并于入室、插管即刻、插管后1、3、5 min(T_0、T_1、T_2、T_3、T_4)5个时间点,记录平均动脉压(MAP)、心率(HR),同时监测血浆肾上腺素(E)、血管紧张素Ⅱ(ATⅡ)。结果 (1)血流动力学变化:与T_0比较,A_1、B_1组患者MAP在T_1时明显降低(P<0.05)。与T_1比较,除A_1组外其余各组患者MAP、HR均于T_2时开始升高(P<0.05),且B_3组患者MAP在T_2、T_3和T_4时均明显高于A_3组(P<0.05)。(2)激素水平变化:与T_1比较,A_3、B_2组患者E水平于T_2时开始升高(P<0.05),ATⅡ水平于T_3时开始升高,B_3组患者E和ATⅡ水平均于T_2时开始升高(P<0.05),并持续到T_4时(P<0.01)。B_3组患者ATⅡ水平在T_2、T_3和T4时均明显高于A_3组(P<0.05)。结论与气管内插管相比,SLIPA^(TM)喉罩引起的应激反应较小。BIS 50是置入SLIPA^(TM)喉罩比较合适的麻醉深度。

Objective To study the changes in hemodynamics, concentrations of epinephrine （E） and angiotensin （AT Ⅱ） in plasma when the SLIPATM laryngeal mask or tracheal tube was inserted at different depths of anesthesia for the purpose of analyzing the optimum anesthesia depth for the SLIPATM laryngeal mask and its effects on stress responses. Methods 120 patients were divided into six groups according to the airway management and bispectral index（BIS） ,i. e. A1, A2, A3, B1, B2 and B3. The SLIPATM laryngeal mask or tracheal tube was inserted respectively, when BIS was 40,50 and 60. Hemodynamics（ MAP, HR）and blood samples for adrenaline and angiotensin Ⅱ were collected at different time points, i.e. base, insertion, 1,3 and 5 min after insertion （ TO, T1, T2,T3,T4）. Results （1）Changes in hemodynamics： MAP in groups Aland B1 at T1 decreased in comparison with TO. Compared with T1, MAP and HR in each group increased from T2 except group A1 （ P 〈 0.05 ）. Moreover, MAP in group B3 was significantly higher than that in group A3 at T2,T3 and T4（P 〈0. 05）. （2）Changes in the stress level： compared with T1, adrenaline concentration in group A3 and B2 increased from T2 （ P 〈 0. 05 ）, but angiotensin Ⅱ concentration from T3. Furthermore, both adrenaline and an- giotensin Ⅱ in group B3 increased from T2 to T4 （ P 〈 0. 05 or P 〈 0.01 ）. Angiotensin Ⅱ at T2, T3 T4 were higher in group B3 than those in group A3 （ P 〈 0.05 ）. Conclusions BIS 50 is an appropriate depth of anesthesia for SLIPATM laryngeal mask insertion, with few effects on stress responses, compared with endotracheal intubation.