SLIPA喉罩在全麻下乳腺癌根治术中的应用

The application of SLIPA laryngeal mask in general anesthesia radical mastectomy

目的:观察SLIPA喉罩用于全身麻醉下乳腺癌根治术的可行性和安全性。方法:择期乳腺癌根治术患者56例,ASAⅠ～Ⅱ级,年龄45～68岁,体重46～65 kg,随机分为两组(n=28):喉罩组(L组)及气管插管组(C组),两组患者均麻醉前30 min肌注苯巴比妥钠100 mg、阿托品0.5 mg。入室后常规监测心电图(ECG)、血压(BP)、心率(HR)、脉博氧饱和度(SpO2)等,开放静脉通道后,依次注入咪唑安定0.06 mg/kg、芬太尼0.1 mg、阿曲库铵0.8 mg/kg、异丙酚1.0 mg/kg,待肌松完善后分别插入SLIPA喉罩或气管导管,接麻醉机行机械通气。麻醉维持:微泵持续泵注异丙酚3～5 mg/(h.kg)和瑞芬太尼0.01～0.02 mg/(h.kg)。若自主呼吸恢复则保留自主呼吸,必要时手控辅助呼吸,维持PETCO2在35 mmHg左右。手术结束前5 min停药,手术结束后待呼吸频率≥16次/min,患者意识、咳嗽、吞咽反射等均恢复后拔除喉罩或气管导管。分别于插管(喉罩)时、切皮时及拔管(喉罩)时记录平均动脉压(MAP)、HR、SpO2的值,观察并记录各组术中麻醉药用量及术后发生呛咳、咽痛、恶心呕吐、声嘶等并发症的例数。结果:两组病例的麻醉均能较好地满足手术的要求,整个手术过程中呼吸循环功能稳定。L组患者术中麻醉药用量和术后并发症发生率明显低于C组(P%0.05)。结论:SLIPA喉罩用于全麻下乳腺癌根治术安全、可靠。

Objective：To observe the feasibility and safety of SLIPA laryngeal mask in general anesthesia （LMA） radical mastecto- my. Methods： Select 56 cases of radical masteetomy： grade ASA I - Ⅱ , 25 to 68 years old, weighing 46 to 65 kg. Then randomly divide them into two groups （n =28） ： the LMA group （group H） , and the intubation group （group C）. The patients in both groups are intramuscular injected with phenobarbital sodium 100 mg and atropine 0.5 mg 30 minutes ahead of anesthesia. Routine monitor the ECG, BP, HR, SpO2 after the patient entered into the operation room. After the expansion of intravenous, inject midazolam 0.06 mg/kg, fentanyl 0.1 mg, atracurium 0.8 mg/ kg and propofol 1.0mg/kg. After the completion of muscle relaxation, insert SLI- PA laryngeal mask or tracheal tube, and then practice mechanical ventilation with the anesthesia machine. Maintenance of anesthesia： practice sustained micro-pump implantation with propofol 3 - 5 mg/kg and remifentanil 0.01 to 0.02 mg / kg. If the patient recovered from autonomous respiration, keep it and assist with manual respiration when necessary. Maintain P^T C02 at the level of about 35mmHg. Stop drug-using 5 minutes ahead of the end of surgery and wait until the breathing frequency ≥ 16 times / min. After the patient＇s consciousness, coughing, swallowing reflex are recovered, remove the laryngeal mask or tracheal tube. Record the exact fig- ures of mean arterial pressure （MAP） ,beart rate （HR） and pulse oxygen saturation （SPO2 ） during the process of intubation, skin in- cision and extubation. Observe and record the doses of anesthetics and the cases of postoperative complications, such as bucking, pharyngalgia, nausea and vomiting, hoarseness and so on. Results：The anesthesia of two groups can better meet the requirements ofthe surgery. The respiratory function is stable throughout the whole procedure. The doses of anesthetics and post-operative complica- tions of patients in group H are fewer than group C （ P 〈 0.05 ）. Conclusion ： It is safe and reliable to apply SLIPA laryngeal mask in general anesthesia radical mastcctomy.