一次性双管喉罩和气管导管应用于介入神经外科全麻患者苏醒期生命体征的临床观察

Clinical observation of the maintenance of breathing and waking vital signs of LMA SupremeTM and endotracheal tube(ET) in patients with general anesthesia in neurosurgery

目的比较一次性双管喉罩(LMA SupremeTM)与气管导管应用于介入神经外科全麻患者苏醒期的生命体征,观察LMASupremeTM在介入神经外科手术中应用的安全性。方法择期行介入神经外科手术全麻患者40例,ASAⅠ～Ⅱ级,随机分为LMASupremeTM(A组)和气管导管(B组),每组20例。于麻醉注药前(T0)、麻醉注药结束前(T1)、手术结束时(T2)、拔管前(T3)、拔管后(T4)、拔管后5min(T5)观察心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),并观察患者有无呛咳反应。结果 A组无发生呛咳者;A组患者T1、T2、T3、T4、T5与T0时比较HR、SBP、DBP、MAP、SpO2差异无统计学意义(P>0.05);B组患者T1、T2、T5与T0时比较HR、SBP、DBP、MAP、SpO2差异无统计学意义(P>0.05),T3、T4与T0时比较HR、SBP、DBP、MAP差异有统计学意义(P<0.05),SpO2差异无统计学意义。结论在介入神经外科手术中,应用LMASupremeTM作为全身麻醉呼吸通道管理,患者在苏醒期生命体征的改变不会出现剧烈的波动,可以预防正常灌注压突破综合征(NPPB)的发生,能更好地保证患者的安全。

Objective To compare the vital signs of LMA Supreme^TM with endotracheal tube in patients with gener- al anesthesia in neurosurgery and explore the application of LMA Supreme^TM in neurosurgery. Methods Forty selective surgery patients with general anesthesia for neurosurgery, staged as ASA Ⅰ - Ⅱ, were randomly divided into two groups （n=20）： the LMA Supreme^TM group （Group A） and the endotracheal tube group （Group B）. During operation, the heart rate （HR）, systolic blood pressure （SBP）, diastolic pressure （DBP）, mean arterial pressure （MAP）, pulse blood oxygenstaturation （SpO2） were observed at before medication（T0）, the end of anesthesia medication admission（T1）, before the end of operation （T2）, before tube withdrawal （T3）, after tube withdrawl （T4）, 5 minutes after tube withdrawal （T5）. Patients were observed for choke cough reaction. Results LMA SupremeTM could effectively reduce the stimulation of intubation to the trachea which may cause choke cough, and the response rate was low. In Group A, the HR, SBP, DBP, MAP, SpO： in patients at T1, T2, T3, T4, T5 and before operation was not significantly different from those at To （P 〉 0.05）. The HR, SBP, DBP, MAP, SpO2 at T1, T2, T5 was significantly different than that at To （P 〉 0.05） in Group B. The HR, SBP, DBP, MAP of patients at T3, T4 was significantly different than those before the operation （P 〈 0.05）, however, there was no significant difference in SpO2. Conclusion In interventional neurosurgery, LMA SupremeTM application can prevent the occurrence of normal per- fusion pressure breakthough syndrome （NPPB） and ensure the safety of patients because it can be used for air- way management and prevents violent fluctuation of vital signs.