麻醉诱导期Slipa喉罩和气管导管对眼的影响

Comparison the effect of supralaryngeal airway and endotracheal catheter on the eye during induction of general anesthesia

目的比较麻醉诱导期Slipa喉罩和气管导管对患者眼的影响。方法乳腺良性病变切除术50例，年龄20～50岁，体质量45—70kg，眼压（IOP）12～18mmHg（1mmHg=0．133kPa），按照随机数字表法平均分为两组：Slipa喉罩组（s组）和气管导管组（c组）。两组均静脉注射丙泊酚、瑞芬太尼、顺苯磺阿曲库铵行麻醉诱导，待下颌松弛后s组置入Slipa喉罩，C组插入气管插管后行机械通气。于诱导前（基础值11D）、插管或置喉罩前（T1）、插管或置喉罩后即刻（T2）、插管或置喉罩后1min（T3）、2min（T4）、5min（T5）测定IOP、平均动脉压（MAP）和心率（nR）。结果与rm比较，两组在T1时点IOP、MAP及HR明显降低；与T1比较，S组存T2-T5各时点IOP、MAP及HR均趋于平稳，差异无统计意义，C组1、2、13、T4各时点IOP、MAP及HR明显升高，T5时点IOP、MAP及HR均下降；与s组比较，C组T2、T3、T4各时点IOP、MAP及HR升高，T1和T5两时点组间比较，差异无统计学意义；S组和C组MAP与IOP呈正相关（r=0．832，0．829，P〈0．05）。结论与气管插管相比，Slipa喉罩在麻醉诱导中的应用可有效预防IOP的升高，且麻醉诱导过程血流动力学趋于稳定。

Objective To compare the effect of supralaryngeal airway （Slipa） and endotracheal catheter on the eye during induction of general anesthesia. Methods Fifty patients aged 20 - 50 years old with weight 45 -70 kg and intraocular pressure （IOP） 12 - 18 mmHg received elective benign breast neo- plasm resection surgery and were randomly divided into 2 groups：S group （Slipa） and C group （endotracheal catheter）. Anesthesia was induced with intravenous propofol and remifentanil until loss of the eyelash reflex. Cisatracufium was then administered. When the jaw was flabby, Slipa was inserted to trachea and the intubation was performed with mechanical ventilation. The IOP, mean arterial pressure （MAP） , and heart rate （HR） were measured and recorded before anesthesia induction （T0）, before intubation（ T1 ）, after intubation immediately（T2）, at 1 min（T3）, 2 min（T4）, 5 min（TS） after intubation. Results Compared with TO, the IOP, MAP and HR were significantly lower than those at T1. Compared with T1 in group S, the IOP, MAP and HR in T2 - T5 were more stable. In group C, the IOP, MAP and HR significantly increased at T2,T3 ,T4. Compared with group S, the IOP, MAP and HR in group C were significantly higher at T2,T3, T4. The MAP was positively correlated with the IOP in group S and group C （ r = 0. 832 and 0. 829, respectively）. Conclusion Supralaryngeal airway is better than endotracheal catheter in preventing the increase of IOP and keeping stable hemodynamic responses during induction of general anesthesia.