鼻咽通气道联合面罩通气在乳腺肿块切除术中的应用

Application of Nasopharyngeal Airway Combined with Face Mask Ventilation in Surgical Removal of Breast Lumps

目的探讨鼻咽通气道联合面罩通气在乳腺肿块切除术中的可行性和安全性。方法将60例行乳腺肿块切除术患者按不同的通气方式分为2组。鼻咽通气道联合面罩组(A组)30例,喉罩组(B组)30例。观察2组患者诱导前(T0)、插入通气罩即刻(T1),插入通气罩后5(T2)、10(T3)min及手术开始后5(T4)、10(T5)min和拔出通气罩即刻(T6)的平均动脉压(MAP)、心率(HR)、呼气末二氧化碳浓度(PETCO2)和使用七氟烷吸入的浓度;记录2组患者苏醒时间(停用七氟醚至呼之睁眼)、拔除通气罩的时间(停用七氟醚到完全苏醒)及不良反应(术中上呼吸道梗阻、反流误吸、体动及术后咽部不适)的发生等情况。结果 2组患者诱导后均能较好的保留自主呼吸。B组患者在T1、T6时间点HR、MAP均较A组明显升高,差异均有统计学意义(均P<0.05);2组患者在T1、T2时间点PETCO2均较T0升高,差异均有统计学意义(均P<0.05)。B组患者在T2、T3时间点使用七氟烷吸入的浓度均明显高于A组,差异均有统计学意义(均P<0.05)。A组患者苏醒时间、拔除通气罩时间与B组比较差异均无统计学意义(均P>0.05)。B组患者术后咽部不适发生率明显高于A组,差异有统计学意义(P<0.05)。结论鼻咽通气道联合面罩通气能够安全、有效的运用于乳腺肿块切除术中。

Objective To investigate the feasibility and safety of nasopharyngeal airway combined with face mask ventilation in surgical removal of breast lumps.Methods Sixty patients undergoing surgical removal of breast lumps were randomly assigned to receive either nasopharyngeal airway combined with face mask ventilation（group A,n=30） or laryngeal mask airway（group B,n=30）.Mean arterial pressure（MAP）,heart rate（HR）,end-tidal carbon dioxide concentration（PETCO2） and inhaled concentration of sevoflurane were determined before induction（T0）,at 0,5 and 10 minutes after the insertion of nasopharyngeal airway or laryngeal mask airway（T1,T2 and T3）,at 5 and 10 minutes after the start of surgery（T4,T5）,and at the end of ventilation（T6）.In addition,wake-up time（the period from stopping sevoflurane inhalation to eye opening）,the time of ventilation mask removal（the period from stopping sevoflurane inhalation to wake-up） and adverse reactions（upper airway obstruction during surgery,regurgitation and aspiration during anesthesia,body movement and postoperative throat discomfort） were recorded in both groups.Results All patients could keep spontaneous breathing well after induction.The PETCO2 at T0 was significantly lower than that at T1 or T2（P0.05）.Compared with group A,the MAP and HR measured at T1 and T6 and inhaled concentrations of sevoflurane measured at T2 and T3 obviously increased in group B（P0.05）.There were no significant differences in wake-up time and time of ventilation mask removal between the two groups（P0.05）.Moreover,the incidence of postoperative throat discomfort in group B was obviously higher than that in group A（P0.05）.Conclusion Nasopharyngeal airway combined with mask ventilation is effective and safe in surgical removal of breast lumps.