喉罩通气在胸腔镜胸交感神经链切断术中的临床研究

Comparison of laryngeal mask and double-lumen endotracheal intubation in endoscopic thoracic sympathectomy

目的:评价喉罩通气在胸腔镜胸交感神经链切断术中应用的效果。方法:选择手多汗症行胸腔镜胸交感神经链切断术患者60例,随机分为A组(喉罩组)与B组(双腔气管插管组),每组30例。A组在手术者打开左右胸腔前暂停呼吸机,打开喉罩管接头,使喉罩导管与大气相通,手术中采用低潮气量(3～4 mL/kg)通气完成手术操作。B组分次行左右侧单肺通气下完成胸交感神经链切断术。记录2组患者各时间点的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳(PETCO2),并观察2组患者有无反流误吸情况及术后咽喉部并发症等。结果:喉罩置入一次成功率100%,喉罩置入较气管插管成功所需时间明显缩短,2组患者在手术期间均未发生低氧血症和二氧化碳蓄积,SPO2、PetCO2均在正常范围,2组间差异无统计学意义(P>0.05)。B组插气管双腔管和拔除气管双腔管时,血压增高、HR加快明显高于A组(P<0.05)。A组躁动、呛咳的发生率低于B组(P<0.05)。结论:喉罩通气全身麻醉用于胸腔镜胸交感神经链切断术,可确保气道通畅,低潮气量通气时不仅术野暴露清楚,也可保证基本的通气量,与双腔支气管插管比较,用喉罩通气全身麻醉时具有操作容易、管理简单、且术后并发症少等优点。

Objective：To investigate the effects and safety of laryngeal mask and low tidal volume ventilation in endoscopic thoracic sympathectomy.Methods：Sixty patients with palmar hyperhidrosis received endoscopic thoracic sympathectomy were randomly divided into two groups according to their airway management,laryngeal mask group（group A,n=30） and double-lumen endotracheal tube group（group B,n=30）.Patients in group B underwent endoscopic thoracic sympathectomy with one-lung ventilation in the lateral position.While in group A,laryngeal mask and low tidal volume ventilation（3-4 mL/kg）were used during the procedure.The values of SBP,DBP,HR,SpO2 and PetCO2 were collected before and after intubation（T0,T1） and extubation（T3,T4） respectively.The occurrence of regurgitation,aspiration and laryngopharyngeal complications were also recorded.Results： The successful rate of laryngeal mask placement was 100%.The time spent in laryngeal mask placement was less than that of double-lumen endotracheal intubation.No hypoxemia or hypercapnia occurred in two groups.There was no significant difference in SpO2 and PetCO2 between groups.Patients in group B showed less BP and HR than that of group A（P 〈 0.05）.The incidence of restlessness,cough,sore throat and hoarseness were less in group B（P 〈 0.05）.Conclusion： General anesthesia with laryngeal mask airway in endoscopic thoracic sympathectomy can keep airway unobstructed,and low tidal volume ventilation makes exposure clearly.Laryngeal mask placement is easy performed and managed and has less complications.Moreover,it can decrease the cardiovascular response obviously and keep hemodynamics stable perioperatively when compared with double-lumen endotracheal intubation.