喉罩通气-静脉辅助麻醉在输尿管镜气压弹道碎石术中的应用

Application of laryngeal mask airway and intravenous assisting anesthesia during ureteroscopic pneumatic lithotripsy

目的:探讨喉罩通气与丙泊酚联合瑞芬太尼靶控输注在输尿管镜下气压弹道碎石术(ureteroscopic pneumatic lithotripsy,URSL)中的麻醉效果和安全性。方法 :选择ASAⅠ～Ⅱ级行URSL的患者40例,随机分为压力支持通气(pressure support ventilation,PSV)组(P组)和容量控制通气(volume control ventilation,VCV)组(V组),每组20例。两组麻醉诱导使用丙泊酚、瑞芬太尼、司可林,静脉注射后置入喉罩,接麻醉机先行VCV。P组待司可林作用消失,自主呼吸恢复后,使用PSV;V组待司可林作用消失,自主呼吸恢复后,静脉注射维库溴铵,继续行VCV。两组维持麻醉均使用丙泊酚联合瑞芬太尼靶控输注,观察P组和V组通气后10 min(T1),20 min(T2),30 min(T3)的BP、ECG、呼吸频率(RR)、气道峰压(Pmax)、平均气道压(Pmean)、血氧饱和度(SpO2)、呼吸末二氧化碳分压(PET-CO2)、动脉血二氧化碳分压(PaCO2)、清醒时间。结果 :两组Pmax、Pmean、清醒时间比较,P组明显小于V组,差异极有统计学意义(P<0.01)。两组BP、SpO2、PETCO2、PaCO2比较差异无统计学意义(P>0.05)。结论:利用喉罩,采用PSV模式,在不需要肌肉松弛的情况下行输尿管镜下气压弹道碎石术,可以减少肌松药的应用,麻醉苏醒快,效果好,安全可靠。

Objective：To study the effect and safety of anesthesia applied laryngeal mask airway combined with target-controlled infusion of propofol and remifentanil in the patients with ureteroscopic pneumatic lithotripsy.Methods：40 patients with ASA I～Ⅱaccepted ureteroscopic pneumatic lithotripsy were randomly divided into two groups,group P（pressure support ventilation,PSV） and group V（pressure volume control ventilation,VCV）,20 cases in each group.Propofol,remifentanil and succinylcholine were used for induction of anesthesia.The first generation of LMA was inserted after induction and VCV was applied in both groups.After the elimination of succinylcholine effect and recovery of spontaneous breathing,PSV was used in the group P,but the group V kept applying VCV after intravenous injection of azamethonium bromide.After 10 min（T1）,20 min（T2） and 30 min（T3） of PSV and VCV,the blood pressure（BP）,eIectrocardiogram（ECG）,respiratory rate（RR）,peak airway pressure（Pmax）,and mean airway pressure（Pmean）,oxygen saturation（SpO2）,pressure of end-tidal carbon dioxide（PETCO2）,pressure of arterial carbon dioxide（PaCO2） and sober time（SB） were observed and recorded.Results：Compared with the group V,Pmax,Pmean and SB in the group P were significantly decreased with statistical significance（P0.01）.Bp,SpO2,PETCO2 and PaCO2 in the two groups had no statistical difference.Conclusion：PSV under general anesthesia in the uretemscope pneumatic lithotripsy may reduce the application of muscle relaxants with quick consciousness recovery,better efficacy,safety and reliability.