Supreme喉罩用于乳腺外科患者全麻手术的价值

Efficacy evaluation of laryngeal mask airway supreme used in breast surgery patient with general anesthesia

目的探讨Supreme喉罩在乳腺外科患者全麻手术中的临床价值及效果。方法选择80例ASA为Ⅰ～Ⅱ级乳腺外科全麻手术患者,随机分为A组(n=40)应用Supreme喉罩全麻和B组(n=40)应用气管插管全麻。观察记录麻醉诱导前、插管/罩前后、拔管/罩前后等时间点的HR、SBP、DBP的血流动力学变化,记录两组患者术中气道峰压(Ppeak)、呼气末二氧化碳分压(PETCO2)、通气效果及呛咳、体动、反流、误吸、恶心、呕吐及术后咽喉痛等不良反应。结果 B组患者的HR,SBP、DBP在插管和拔管期间比基础值增高(P<0.05),A组与基础值比较没有明显变化;两组患者Ppeak、PETCO2和通气效果一致,组间比较各时间点差异无统计学意义(P>0.05)。两组插管/罩时患者均无呛咳、体动、无反流、误吸(P>0.05);拔管(罩)期间,两组患者均无反流、误吸(P>0.05);A组呛咳、体动及术后咽喉痛的发生明显少于B组(P<0.05)。结论 Supreme喉罩用于乳腺外科患者全身麻醉具有血流动力学定稳、操作简单、不良反应少等优点,可完全替代气管插管用于乳腺外科患者全麻手术,值得临床推广应用。

Objective To investigate the clinical value and effect of laryngeal mask airway supreme（LMA Supreme） in general anesthesia for breast surgery patient.Methods 80 elective patients,ASA grade I ～ II,undergoing breast surgery under general anesthesia were randomly allocated to two groups with 40 cases each.Group A（n = 40） received LMA Supreme and group B（n = 40） received endotracheal tube（ETT）.The hemodynamic changes of HR,SBP,DBP of two groups were recorded before anesthesia induction（baseline）,before insertion and after insertion of ETT/LMA Supreme,before extubation and after extubation of ETT/LMA Supreme.The peak inspiratory airway pressure（Ppeak）,PETCO2 and the effectiveness of ventilation were recorded during each operation.The adverse reactions of anesthesia were recorded included bucking,body movement,countercurrent,aspiration retching,vomiting and postoperative pharyngolaryngeal adverse events during each operation.Results The patients HR,SBP and DBP were found higher than baseline in group B during intubation and extubation（P 0.05）,and were not significantly different at each point in group A（P 0.05）.The Ppeak,PETCO2 and the effectiveness of ventilation were comparable in the two groups at all the time points（P 0.05）.No bucking,body movement,countercurrent and aspiration in the two groups during intubation（P 0.05）.No countercurrent and aspiration in the two groups during extubation（P 0.05）.The patients＇bucking,body movement during extubation and postoperative sore throat in group A were found significantly lower than those in group B（P 0.05）.Conclusion LMA Supreme used in breast surgery patient with general anesthesia has stability on the hemodynamic change,which can insert easy with fewer the adverse effects,making it can be as a substitute for tracheal intubation undergoing breast surgery and it also be worth clinical promotion of applications.