喉罩与气管内插管两种麻醉方法在乳腺癌术中的效果

Anesthesia effect of laryngeal mask and endotracheal intubation in breast cancer surgery

目的通过比较喉罩麻醉（LMA）与气管内插管麻醉（ETA）在乳腺癌术中的麻醉效果，以探讨LMA的有效性与安全性。方法以2011年5月至2013年6月在浙江萧山医院乳腺外科行乳腺癌根治手术的86例患者为研究对象，按随机数字表格法将86例患者分为对照组和观察组，各43例。两组患者手术前均采用同种麻醉诱导方案，对照组患者接受ETA，观察组患者接受LMA，比较两组患者麻醉效果。结果两组患者在麻醉前、插管或放置喉罩后5min、拔除导管或摘除喉罩后5min时的舒张压（DBP）、收缩压（SBP）、血氧饱和度（SpO2）和心率（HR）比较，差异均无统计学意义（均P〉0．05）；而观察组在放置喉罩时和摘除喉罩时DBP、SBP、HR均低于对照组插管时和拔除导管时的DBP、SBP、HR[插管时（67．2±10．3）mmHg vs （88．3±9．1）mmHg，（106．4±12．6）mmHg vs （139．4±13．6）mmHg，（77．5±4．4）mmHg vs （99．4±4．7）mmHg；t值分别为5．12，4．68，4．75，均P〈0．05。拔管时（71．2±8．5）mmHg vs （87．5±6．6）mmHg，（121．3±12．2）mmHg vs （143．3±10．7）mmHg，（78．9±4．8）mmHg vs （98．9±5．0）mmHg，t值分别为4．53，3．89，4．98，均P〈0．05]。观察组在摘罩时呛咳和咽痛的发生率明显低于对照组拔管时呛咳和咽痛的发生率（X^2值分别为73．052和63．999，均P〈0．05）。结论LMA能更好的维持患者血流动力学的平稳，降低拔管或摘罩时的不良反应。

Objective To discuss the effectiveness and safety of laryngeal mask anesthesia （LMA） by comparing the anesthesia effect of LMA and endotracheal intubation anesthesia （ETA） in breast cancer surgery. Methods A total of 86 patients performed breast cancer surgery in breast department of Xiaoshan Hospital of Zhejiang Province from May 2011 to June 2013. They were divided into control group and observation group by random number table method with 43 cases in each group. Two groups used the same anesthesia induction program before surgery. The control group received ETA, while the observation group received LMA. Anesthesia efficacy was compared between two groups. Results The DBP, SBP, SpO2 and HR of two groups were not significantly different before anesthesia, 5rain after intubation or placing laryngeal mask, 5min after removing catheter or removing laryngeal mask （ all P 〉 0.05 ）. However, DBP, SBP, HR of the observation group at placing and removing laryngeal mask were lower than those of the control group at intubation and removing catheter [ intubation （67.2 ±10.3 ） mmHg vs （ 88.3 ± 9.1 ） mmHg, （ 106.4 ± 12.6） mmHg vs （ 139.4 ± 13.6） mmHg, （77.5 - 4.4） mmHg vs （99.4 ± 4.7） mmHg （ t = 5.12, 4.68, 4.75, P 〈 0.05） ; ; removing catheter （71.2 ± 8.5） mmHg vs （ 87.5 ± 6.6） mmHg, （121.3 ± 12.2）mmHg vs （143.3 ±10.7）mmHg, （78.9 ±4.8）mmHg vs （98.9 ±5.0）mmHg, t =4.53, 3.89, 4.98, all P〈0.05]. The incidence of cough and sore at removing laryngeal mask in the observation group ws significantly lower than that at extubation in the control group （X^2 value was 73. 052 and 63. 999, respectively, both P 〈 0.05 ）. Conclusion LMA can better maintain the stability of hemodynamies and reduce the adverse reactions at extubation or removin or removing mask.