喉罩过渡对双腔气管导管拔管期应激反应的影响

The effect on the strees response of laryngeal mask airway as a transition method after double endotracheal anesthesia

目的研究喉罩过渡法对支气管内麻醉中双腔气管导管拔管期应激反应的影响。方法选择全身麻醉并行双腔气管导管插管手术患者90例，随机分为A、B、C组，每组30例。A组在手术结束后直接拔除双腔气管导管，B组术后深麻醉下更换单腔气管导管，C组在术后深麻醉下更换喉罩。分别记录手术结束时（T0）、拔除气管导管（喉罩）前1min（T1）、拔除后1min（T2）、5min（T3）的MAP、HR、心率收缩压乘积（RPP）。观察三组呛咳、躁动等不良反应发生情况。结果与T0时比较，T1～T3时A、B组MAP、RPP明显升高，HR明显增快（P〈0．01或P〈0．05）。与A组比较，T1～T3时B、C组MAP、RPP明显降低，HR明显减慢（P〈0．05）。C组严重呛咳、躁动例数均明显低于A、B组（P〈0．05）。结论在双腔气管插管麻醉苏醒期使用喉罩过渡法可以减少苏醒期血流动力学波动，降低拔管期应激反应。

Objective This study was to investigate the effect of using laryngeal mask airway （LMA） as a transition method after double lumen endotracheal anesthesia on the stress response during the extubation period. Methods Ninety patient underwent general anesthesia with double lumen endotracheal intubation were randomly divided into 3 groups： group A, B and C （n=30）. Patients in group A were extubated directly after surgery. The double lumen endotracheal tube were changed to single lumen endotracheal tube under deep anesthesia in group B patients, while the double lumen en dotracheal tube were changed to LMA in group C. MAP, HR and rate pressure product （RPP） at the end of surgery （T0）, 1 minute before extubating the endotracheal tube （laryngeal mask） （T1）, 1 minutes （T2）, 5 minutes after extubating （T3） were recorded. The reaction of extubation, such as bucking or restlessness, was also observed. Results Compared with T0, the MAP, HR, and RPP were significantly increased in groups A and B at T1-T3 （P〈0.05）. Compared with group A, the MAP, HR, RPP were significantly decreased in groups B and C at T1-T3 （P〈0. 05）. The number of bucking and restlessness in group C were lower than that in group A and group 13 （P （0. 05 ）. Conclusion The use of laryngeal mask during the transition period in double lumen endotracheal anesthesia to can reduce hemodynamic fluctuations and stress reaction during the extubation.