双管喉罩全麻在动脉瘤介入栓塞手术中的应用

Application of Proseal Laryngeal Mask Airway in General Anesthesia During Cerebral Aneurysm Embolism Surgery

目的探讨双管喉罩置入全身麻醉在颅内动脉瘤介入栓塞手术中的麻醉效果。方法 60例脑动脉瘤介入手术患者,随机分为喉罩组(PLMA组,n=30)和气管插管组(TT组,n=30),监测记录两组患者麻醉诱导前(T0)、置入喉罩或气管导管前1 min(T1)、置入喉罩或气管导管即刻(T2)、置入后5 min(T3)、拔喉罩或导管即刻(T4)、拔除后5min(T5)时HR、MAP的变化;观察记录两组患者术中丙泊酚、雷米芬太尼的总泵入量;记录拔除喉罩或气管导管前后是否出现呛咳、体动、反流、恶心、呕吐、误吸等;术后随访有无咽喉痛、腹胀、声音嘶哑等并发症。结果 PLMA组在T2、T3、T4、T5各时点的HR、MAP值较TT组有明显的降低(P<0.05);PLMA组患者术中丙泊酚、雷米芬太尼的总用药量明显低于TT组(P<0.05),两组并发症差异无统计学意义。结论双管喉罩全麻能更好地维持血流动力学的稳定,有效地减少麻醉用药量,是一种安全有效的麻醉方式。

Objective To explore the safety and efficacy of proseal laryngeal mask airway （PLMA） in general anesthesia during cerebral aneurysm embolism surgery. Methods 60 patients ASA ]I to 11I, undergoing cerebral aneurysm embolism surgery, were randomly assigned into PLMA group（ group PLMA n = 30） or endotracheal intubation group（ group TT n = 30）. MAP, HR and SpO2 were monitored before induction, 1 min before and 5 min after PLMA insertion or endotracheal intubation, PLMA or endotracheal extubation and 5 min after extubation. Propofol and remifentanil usage as well as complications were recorded. Results MAP and HR of group PLMA were lower than group TT at every time points （ P 〈 0.05 ） ; The dosage of propofol and remifentanil were lower in group PLMA compared with group TT（ P 〈 0.05 ） ;There were no significant differences in complications between two groups. Conclusion PLMA intubation was efficient to maintein hemodynamic stable and reduce anesthetics doseage as well. PLMA was safe and efficient in general anesthesia during cerebral aneurysm embolism surgery.