喉罩通气全身麻醉复合臂丛阻滞麻醉在上肢手术中的疗效观察(附32例报告)

Cure Effect of Laryngeal Mask Airway under General Anesthesia with Brachial Plexus Anesthesia on Arm Operation

[目的]探讨喉罩通气全身麻醉复合臂丛阻滞麻醉在上肢手术中的应用。[方法]选择择期行上肢手术患者32例,随机分成两组,每组16例,喉罩通气全身麻醉复合臂丛阻滞麻醉组为I组;气管内插管全身麻醉组为Ⅱ组。Ⅰ组先在神经刺激仪定位下,予以2%利多卡因10mL与0.75%罗哌卡因(耐乐品)10mL混合液注入患侧肌间沟行臂丛神经阻滞,再以顺阿曲库胺0.2mg·kg-1、芬太尼2～3μg·kg-1、丙泊酚1～2mg·kg-1静脉诱导后置入喉罩。Ⅱ组单纯以顺阿曲库胺0.2mg·kg-1、芬太尼2～3μg·kg-1、丙泊酚1～2mg·kg-1静脉诱导后气管内插管。观察喉罩置入或气管插管后1min(T)1、术中30min(T)2、术毕(T)3时间点的心率(HR)、血压(BP)、呼气末二氧化碳分压(PETCO2)、七氟醚最低肺泡有效浓度(MAC)及术中维持芬太尼用量与顺阿曲库胺用量,记录术后疼痛程度。[结果]Ⅰ、Ⅱ组的HR、BP及PETCO2无明显差异,MAC及维持芬太尼用量与顺阿曲库胺用量均低于Ⅱ组,Ⅰ组术后镇痛明显优于Ⅱ组,差异有统计学意义(P<0.05)。[结论]喉罩通气全身麻醉复合臂丛阻滞在上肢手术中能有效降低患者全身麻醉药物的使用量,减少术后并发症的发生,改善患者术后疼痛。

[Objective]To investigate the application of general anesthesia laryngeal mask airway with the brachial plexus anesthesia in arm operations.[Method]32 patients scheduled for arm operations were selected and randomly divided into two groups： 16 patients with general anesthesia laryngeal mask airway with the brachial plexus anesthesia were Group I and the rest with endotracheal intubation under general anesthesia were Group Ⅱ.Group I were firstly injected with the mixed solution of 10 mL 2% Lidocaine 10 mL 0.75% Ropivacaine（Naropin） into ipsilateral interscalene for brachial plexus block located by a nerve stimulator and then given 0.2mg.kg-1 Cisatracurium,2-3μg.kg-1 Fentanyl,and 1～2mg.kg-1 Propofol via vein induction into laryngeal mask.Group Ⅱ were only given 0.2mg.kg-1 Cisatracurium,2～3μg.kg-1 Fentanyl,1～2mg.kg-1 Propofol via vein induction for tratracheal intubation.The heart rate,blood pressure,partial pressure of end-tidal carbon dioxide（PETCO2）,minimum alveolar concentration（MAC） were observed 1 min after laryngeal mask insertion or tratracheal intubation（T1）,30 min during operation（T2） and after operation（T3）.The dosages of Fentanyl and Cisatracurium were also observed during the operation.The degree of pain after operation was recorded.[Results]There was no obvious difference in the heart rate,blood pressure and partial pressure of end-tidal carbon dioxide（PETCO2） between Groups I and Ⅱ.MAC and dosages of Fentanyl and Cisatracurium for Group I were less than those of Group Ⅱ.The pain for Group I was much less than that for Group Ⅱ.All these figures were within statistical error.[Conclusion]General anesthesia laryngeal mask airway with the brachial plexus anesthesia can reduce the dosage of medicine for general anesthesia during arm operations,the side effects and the pain after operation.