喉罩LMA技术联合术中唤醒麻醉应用于脊柱外科手术中的临床体会

Investigation of LMA technique combined with intraoperative wake-up anesthesia applying to the spine surgery

目的通过研究使用喉罩LMA技术联合术中唤醒麻醉应用于脊柱外科手术,以验证喉罩LMA技术联合术中唤醒麻醉中应用的可行性、可控性,及该联合技术在脊柱外科手术中的实用性。方法选择择期行脊柱外科手术的患者60例,随机分成喉罩全麻组(L组)和气管内插管全麻组(Q组)两组,分别在喉罩全麻和气管内插管全麻下进行脊柱外科手术。所有患者均选择以麻醉用药使用TCI技术进行、麻醉深度通过双频指数BIS进行术中麻醉监测管理。结果两组病例术中唤醒实验均成功,两组患者唤醒时间无明显差别。L组患者唤醒过程中各项生命征变化不明显,血流动力学变化明显比Q组平稳(P<0.05),唤醒后躁动、呛咳或恶心呕吐等不良反应发生率明显低于Q组(P<0.05)。结论利用喉罩进行气道管理可以保证气道安全性和优质的麻醉深度可控性,与气管内插管全麻无明显差别,且较后者使患者更加舒适耐受。喉罩LMA技术联合应用于术中唤醒麻醉,确保脊柱外科手术顺利完成。

ObjectiveThis work presents an investigation about the feasibility, controllability and the better utility of the combination of LMA and wake anesthesia applied to spine surgery.Methods 60 cases selective spine surgery patients were randomLy classified into two groups. One group was used the LMA（group L） and the other group was used the endotracheal Intubation. All of the patients were general anesthetized by using the TCI technique and the anesthetic depth was monitored by the bispectral index （BIS） during the operation.Results All patients of the two groups were successfully intraoperative waked up and the wake-up time of the two groups had not obvious difference. The patients of group L kept a stable vital signs and the hemodynamics parameter is better than that of group Q （P〈0.05）. Additionally, the incidence of adverse reaction such as dysphoria,cough and postoperative nausea and vomiting was obviously lower than that of groups Q （P〈0. 05）. Conclusion It is shown that the LMA technique can ensure the safety of airway and the controllable of anesthetic Depth. Compared to the endotracheal Intubation, LMA has the same anesthesia effects and better comfort. Laryngeal mask airway technique combined with the intraoperative wake-up anesthesia can effectively guarantee the successfully completion of spine surgery.