Supreme喉罩在合并心肺疾病老年患者直肠癌根治术中的应用

The application of the Supreme LMA in elderly patients with cardiovascular and respiratory diseases during radical resection of rectal carcinoma

目的观察Supreme喉罩在合并心肺疾病老年患者直肠癌根治术中的应用效果。方法择期全麻下行直肠癌根治术患者80例,年龄75～92岁,ASAⅡ或Ⅲ级,均合并心血管和/或呼吸系统疾病,随机均分为喉罩组(L组)和气管导管组(T组)。术中采用丙泊酚全凭静脉麻醉。记录入室后(基础值,T0)、插管(喉罩)即刻(T1)、插管(喉罩)后1min(T2)、3min(T3)、5min(T4)、拔管(喉罩)即刻(T5)、拔管(喉罩)后1min(T6)、3min(T7)、5min(T8)时的MAP、HR和BIS。记录丙泊酚、舒芬太尼、维库溴铵用量和手术时间、清醒时间、拔管时间。分别于术前、手术开始后1h、术后24、48h采集患者动脉血行血气分析。记录术后咽痛、声嘶、低/高血压、心律失常、哮喘、呼吸衰竭等并发症发生情况。结果 T2、T3时T组MAP明显高于、HR明显快于T1时和L组(P<0.05),T6、T7时T组MAP明显高于、HR明显快于T5时L组(P<0.05)。L组丙泊酚、舒芬太尼、维库溴铵使用量明显少于T组(P<0.05);清醒时间、拔管时间明显短于T组(P<0.05);T组术后24h的pH值、PaO2明显低于、PaCO2明显高于术前(P<0.05);术后48h的pH值、PaO2明显低于、PaCO2明显高于术前和L组(P<0.05)。L组术后咽痛、呼吸衰竭例数明显少于T组(P<0.05)。结论 Su-preme喉罩应用于合并心肺疾病老年患者直肠癌根治术全身麻醉效果比气管插管更好,保持循环、呼吸平稳所需麻醉性镇静、镇痛、肌松药较少,术后不良反应少,值得在临床推广应用。

Objective To investigate elderly patients with cardiovascular and the effects about the application of the Supreme LMA in respiratory diseases during radical resection of rectal carcinoma. Methods Eighty ASA Ⅱ or Ⅲ elderly patients with combined heart and lung disease, aged 75-92 years, scheduled for radical resection of rectal carcinoma under general anesthesia, were randomly divided into 2 groups： the supreme LMA group （group L） and the endotracheal intubation group （group T）. Total intravenous anesthesia with propofol was used during operation. The MAP, HR and BIS were recorded after enter operating room（the base value, T0）, the moment of intubation （LMA insertion, T1 ）, 1,3,5 min after intubation（T2 T4 ）, the moment of extubation （T5） and 1,3,5 min after extubation （T6-T8）. The dosage of propofol, sufentanil and vecuronium bromide and the operation time, waking hours, extubation time were recorded. Arterial blood were extracted for blood gas analysis before operation, 1 h after the operation beginning and 24,48 h after operation. To record intraoperative awareness and pharyngalgia, hoarseness, serious high or low blood pressure and arrhythmia, asthma, respiratory failure. Results MAP was higher and HR was faster than T1 and group L in group T at T2 ,T3 （P〈0.05）. MAP was higher and HR was faster than T5 and group L in group T at T6, T7 （P〈0. 05）. The requirements of sufentanil, propofol and vecuronium Security were less, the time of awake and extubation in group L were shorter than those in groop T. Compared to pre-operation, pH and PaO2 were significantly decreased while PaCO2 were increased 24 h after operation in group T （P 〈 0.05）. Compared to group L and pre-operation, pH and PaO2 were significantly decreased while PaCO2 were increased 48 h after operation in group T（P〈0.05）. The patients who was arrhythmia and respiratory failure after operation were less in group L compared with group T （P〈0.05）. Conclusion The intubation in elderly patients with combined carcinoma, with fewer postoperative adverse application on clinic. application of Supreme LMA is superior to endotrache heart and lung disease during radical resection of rectal reactions, then super LMA is worth generalization and