食管引流型喉罩应用于全麻乳腺癌改良根治术的临床观察

Clinical observations of Proseal Laryngeal Mask Airway on General Anesthesia in Modified Radical Mastectomy

目的探讨食管引流型喉罩应用于全麻下乳腺癌改良根治术中对麻醉质量影响的临床观察。方法选择在全麻下行乳腺癌改良根治术,ASAⅠ～Ⅱ级、NYHAⅠ～Ⅱ级的患者90例,随机分为气管插管组(T组)和食管引流型喉罩组(P组),每组各45例。监测2组患者入室时(T0)、诱导插管时(T1)、插管后3 min(T2)、停麻醉药时(T3)、苏醒拔管时(T4)、苏醒拔管后15 min(T5)的收缩压(SBP)、舒张压(DBP)、心率(HR)、血氧饱和度(SPO2)、呼气末二氧化碳分压(PETCO2)等变化,并观察患者围手术期呼吸系统等及术后12 h、24 h、48 h的相关并发症。结果 (1)2组术中SPO2差异无统计学意义(P>0.05);(2)2组T0时SBP、DBP差异无统计学意义;2组T1时的SBP、DBP与T0比较均显著性降低(P<0.05),组间差异无统计学意义(P>0.05);T组T2、T4、T5时SBP、DBP与T0比较显著性升高(P<0.05),P组同时间点差异无统计学意义(P>0.05)。T组T2、T4、T5时SBP、DBP与P组比较显著性升高(P<0.05);(3)2组T0时HR差异无统计学意义;2组HR在T1～T5与T0比较均显著性升高(P<0.05),T2、T4、T5时T组明显高于P组(P<0.05);(4)2组患者T2时PETCO2与T3～T5比较差异无统计学意义(P>0.05);T组T2、T4、T5的PETCO2明显低于P组,差异有统计学意义(P<0.05);(5)术后P组咽喉痛、声音嘶哑、咳嗽等并发症发生率低于T组(P<0.05)。结论食管引流型喉罩在全麻乳腺癌改良根治术中可提高围手术期麻醉质量,促进患者血流动力学稳定,减少围手术期并发症,比较适合于全麻乳腺癌改良根治术等短小手术中的应用。

Objective To investigate the influences of proseal laryngeal mask airway on general anethesia in the modified radical mastectomy.Methods Ninety patients（ASAⅠ-Ⅱ,NYHA Ⅰ-Ⅱ）undergone the modified radical mastectomy were randonly assigned to proseal laryngeal mask airway（PLMA）（P groups,n=45） groups and endotracheal intubation（T groups,n=45） groups.The changes of systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heat rate（HR）,saturation of blood oxyge（SPO2）,artrial partial pressure of carbon dioxid（PETCO2） were recorded after the operating room（T0）,intubation time（T1）,3min after intubation（T2）,Withdrawal time（T3）,awake extubation（T4）,15minutes after awake extubation（T5）.And observe the respiratory comlications of the patient such as the sore throat,hoarseness,cough in the perioperative and after the operation 12 h,24 h,48 h.Results（1） There were no significant differences in SPO2 in operations（P〈0.05）;（2） Changes of SBP,DBP in T1 were significantly lower than those in T0（P〈0.05）.but there were no significant differences between two groups（P〈0.05）;Changes of SBP,DBP in T groups in T2 、T4 、T5 were higher than that T0（P〈0.05）,but they are similar in P groups（P〈0.05）;Changes of SBP,DBP in T groups in T2、T4、T5 were significantly higher than those of P groups（P〈0.05）;（3） HR in（T1-T5） were much higher than those in T0 between two groups（P〈0.05）,HR of T groups in T2、T4、T5 were higher than those of the other groups（P〈0.05）;（4） PETCO2 in T3、T4、T5 compred in T2 were no significant differences between two groups（P〈0.05）;The patients of T groups in T2、T3、T5 were significantly lower than those of P groups（P〈0.05）;（5） The incidence of complications such as sore throat,hoarseness,cough in P groups was significantly lower than those of T groups（P〈0.05）.Conclusion PLMA enhauces the quality of anesthesia in the modified radical mastectomy and promote hemodynamic stability and reduce perioperative complications;it＇s stable and safe specially in small and short operations.