全麻下经Cookgas air-Q喉罩实施老年患者气管超声内镜引导针吸活检术的临床研究

The evaluation of general anesthesia with Cookgas air-Q laryngeal mask in ultrasound-guided transbronchial needle aspiration

目的 探讨Cookgas air-Q喉罩应用于全麻老年患者行经气管超声内镜引导针吸活检术（endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA）的有效性和安全性。方法 选择ASAⅠ~Ⅲ级拟行EBUS-TBNA老年患者30例,随机分为表面麻醉复合静脉镇静组（A组）和Cookgas air-Q喉罩全麻组（B组）,每组15例。A组经环甲膜穿刺注入1%丁卡因3 ml,然后静脉恒速输注右美托咪定,靶控输注丙泊酚,若发生呼吸抑制则面罩加压通气至自主呼吸恢复。B组麻醉诱导后,置入Cookgas air-Q喉罩后行容量控制机械通气,丙泊酚和瑞芬太尼维持麻醉。A组患者放置牙垫后直接置入超声内镜;B组患者超声内镜的置入由一特殊L型带侧开口接口经喉罩进入,观察麻醉诱导前（T0）、超声支气管镜置入即刻（T1）、进行针刺活检时（T2）、手术结束即刻（T3）的血流动力学变化,记录术中低氧血症[脉搏血氧饱和度（SpO2）〈90%]的发生率。记录患者和术者对麻醉效果的满意度,麻醉结束时,由患者和术者分别对麻醉效果进行评定。结果 术前两组患者血压和心率（HR）的差异无统计学意义。T1时,A组收缩压（SBP）和舒张压（DBP）均较B组增高,并伴随HR增快（P〈0.05）,两组SpO2在T0、T1和T3均维持正常水平,T2时A组的SpO2低于B组（P〈0.05）。A组有7例发生低氧血症,B组无低氧血症发生。A组患者对麻醉的总体满意率为33%,B组为100%,B组满意度显著高于A组（P〈0.01）;术者对A组麻醉总体满意率为27%,B组为87%,B组满意度显著高于A组（P〈0.01）。结论 Cookgas air-Q喉罩全麻控制通气行EBUS-TBNA,具有血流动力学相对平稳、麻醉效果好、易于术者操作等特点,能够安全地应用于EBUS-TBNA。

Objective To evaluate the value of general anesthesia with Cookgas air-Q laryngeal mask in endo-bronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA）. Methods Thirty patients with ASAⅠ-Ⅲunderwent EBUS-TBNA due to enlargement of mediastinal lymph nodes, were divided into 2 groups （15 patients each）：group A received topical anesthesia of trachea combined with intravenous sedation; group B received general anesthesia with Cookgas air-Q laryngeal mask. The following parameters were observed and recorded：blood pressure, heart rate, pulse oxygen saturation. Overall satisfaction of the patients and surgeons were recorded. Results The blood pressure and heart rate changed significantly when the endoscopic were inserted into the glottis in group A, some patients had a transient res-piratory depression during needle aspiration. Overall satisfaction of group B was better than that of group A. Conclusion General anesthesia with Cookgas air-Q laryngeal mask can effectively control breath and improve operation condition. It is a safe and feasible method for EBUS-TBNA.