七氟烷吸入联合喉罩通气对老年人全身麻醉诱导期的影响

Effect of sevoflurane with laryngeal mask airway on elderly patients during general anesthesia induction

目的 探讨老年人全身麻醉诱导期七氟烷吸入联合喉罩通气的使用效果,为临床合理应用七氟烷及喉罩提供指导.方法 选择40例老年全身麻醉患者,使用随机数字法分为两组,每组20例.S组（七氟烷吸入联合喉罩通气组）采用“肺活量法”吸入诱导,待患者意识消失后置入喉罩.C组（对照组）采用单次静注咪达唑仑、芬太尼、维库溴铵、异丙酚依次诱导,诱导后经口插入气管导管.记录两组患者诱导前（T0）,插管前（T1）,插管后1 min （T2）,插管后5 min （T3）的收缩压（SBP）,舒张压（DBP）,心率（HR）,Narcotrend指数（NTI）及两组患者诱导期间有无屏气、呛咳、喉痉挛等反应.结果 S组插管前、插管后1 min、插管后5 min血压、心率与诱导前差异无统计学意义（P＞0.05）.C组插管前血压[（108.6±8.1） mm Hg,1 mmHg=0.133 kPa]、插管后5 min血压[（114.7±7.5）mm Hg]、插管前心率[（65.5±8.9）次/min]、插管后5 min心率[（66.9±7.8）次/min],插管后1 min血压[（157.5±11.2） mm Hg]、心率[（88.4±8.0）次/min],较诱导前差异有统计学意义（P＜0.05）.S、C组插管前（T1）,插管后1 min（T2）,插管后5 min（T3）的SBP、DBP、HR差异有统计学意义（P＜0.05）.两组患者NTI差异无统计学意义（P＞0.05）,诱导过程均未出现屏气、呛咳、喉痉挛、支气管痉挛等反应.结论 在老年人全身麻醉诱导期使用七氟烷吸入联合喉罩通气,血流动力学平稳,麻醉深度适宜,且诱导过程平稳.

Objective To investigate the effects of scvoflurane with laryngeal mask airway （LMA） on elderly patients during general anesthesia induction, thus offering the rationale for clinical application. Methods Forty patients with ASA I to H scheduled for general anesthesia were enrolled and, by using a random number table, allocated to group S （sevoflurane ＋ LMA group） to undergo inhalation induction at the level of vital capacity followed by placement of LMA when unconscious, and group C （control group） to receive sequential anesthesia by intravenous midazolam, fentynil, vecm＇onium and propofol, and subsequent placement of catheter transorally. The heart rate （HR） , systolic blood pressure （SBP） , diastolic blood pressure（DBP） and Narcotrend index（NTI） were monitored prior to induction（T0）, before intubation（Tl）, 1 rain （T2） and 5 min following intubation （T3）. The presence of breath-holding, bucking and laryngospasm was also monitored. Results The differences in BP and YIR in group S at T1, T2 and T3 were not statistically signifieant when compared with To （all P〉0.05）. Group C was characterized by significant variation in BP [ （108.6±8.1mm） Hg at Tl, （157.5±11.2） mm Hg at T2 and （114.7±7.5） nun Hg at T3, 1 mm Hg=0.133 kPa] and HR [ （65.5±8.9）/min at T1, （88.4±8.0）/min at T2 and （66.9±7.8）/min at T31 when compared with that at To （all P〈0.05）. Significant changes in SBP, DBP and HR, but not NTI, were noted at TI, T2 and T3 in groups S and C （P〈0.05）. No signs of breath-holding, bucking and laryngospasm were reported during intubation. Conclusion The combination of sevoflurane with LMA yields stable hemodynamics, appropriate depth of anesthesia and stabilized induction for anesthesia in the elderly patients.