不同肌松状态下乳癌根治术患者食管引流型喉罩通气效果的观察

Effect of the Radical Mastectomy Patients with Different Muscle Relaxants State Proseal Laryngeal Mask Airway

目的观察不同肌松状态下乳癌根治术患者食管引流型喉罩通气效果。方法选择36例乳癌根治术患者。静脉麻醉诱导后,置入食管引流型喉罩(PLMA)。测量气道密闭压(PTOP),然后调整通气参数,满足通气指标:PETCO230～35mmHg、SpO2≥95%。术中靶控输注丙泊酚、瑞芬太尼维持麻醉。记录TOF值在0～10(T0)、30～40(T1)、60～70(T2)、90～100(T3)时的气道峰压(PPEAK)、气道平台压(PPLAT)、呼出潮气量、PETCO2及循环体征。由PPEAK与PTOP的差值反映漏气量。各时段如未达到通气指标,则需调整通气参数。结果 T3的PPEAK及PPLAT显著升高;T3的PPEAK>25cmH2O及漏气例数显著增多,漏气量明显增大;各时段的呼出潮气量、PETCO2及SpO2无差异。结论肌松由深变浅时,PLMA的漏气发生率及漏气量也随之升高。但通过调节通气参数或麻醉机潮气量补偿,均达到良好的通气效果。

Objective The observed radical mastectomy patients with different muscle relaxants state Proseal laryngeal mask airway effects.Methods Select the 36 cases of breast cancer patients with radical surgery.Intravenous anesthetic induction,placed Proseal laryngeal mask airway（PLMA）.Measuring airway sealing pressure（PTOP）,and then adjust the ventilation parameters to meet the ventilation indicators：PETCO2=30~35mmHg and SpO2≥95%.Intraoperative target controlled infusion of propofol and remifentanil anesthesia was maintained.Record peak airway pressure（PPEAK）,plateau airway pressure（PPLAT）,exhaled tidal volume,PETCO2 and revolving signs when the TOF value 0~10（T0）,30~40（T1）,60~70（T2）,90~100（T3）.PPEAK with PTOP difference reflects the amount of leakage.Failure to achieve ventilation indicators in each period,you need to adjust the ventilation parameters.Results The PPEAK and PPLAT significantly increased at T3;PPEAK＆gt;25cmH2O and leak the number of cases increased significantly,significantly increased amount of leakage at T3;exhaled tidal volume,PETCO2 and SpO2 no difference at all hours.Conclusion Muscle relaxants by deep shallow,the PLMA leak incidence and amount of leakage also will increase.However,by adjusting the ventilation parameters or anesthesia machine tidal volume compensation,and good ventilation effect.