喉罩通气在腹主动脉瘤血管腔内隔绝术麻醉中的应用

Application of propofol-remifentanil anesthesia with laryngeal mask airway ventilation during endovascular graft exclusion of abdominal aortic aneurysm

目的：观察丙泊酚-雷米芬太尼复合麻醉-喉罩（ LMA）通气在腹主动脉瘤血管腔内隔绝术（ EVGE）麻醉中的临床效果。方法15例行腹主动脉瘤EVGE的患者，在充分的术前准备后，入室静脉注射东莨菪碱0．01 mg· kg^-1，麻醉诱导用丙泊酚1．5～2．0 mg·kg^-1、维库溴胺0．08 mg· kg^-1、雷米芬太尼2～4μg· kg^-1， LMA通气；继以丙泊酚4 mg· kg ^-1· h^-1和雷米芬太尼8μg· kg^-1· h^-1持续泵入维持。连续监测无创及有创血压、心率。结果麻醉诱导和术中的血压和心率比麻醉前明显下降（P＜0．05）；插入喉罩及术毕时心率和血压比麻醉诱导后略有增快与升高，但差异无统计学意义（ P＞0．05）。结论丙泊酚-雷米芬太尼麻醉-LMA通气应用于腹主动脉瘤EVGE安全有效。

Objective To observe the outcomes of propofol -remifentanil anesthesia with laryngeal mask airway ventilation during endovascular graft exclusion （EVGE） of abdominal aortic aneurysm .Methods Propofol-remifentanil anesthesia with LMA was performed in 15 patients undergoing EVGE of abdominal aortic aneurysm .Isntravenous scopol-amine 0.01 mg· kg^-1 was injected before anesthesia .Anesthesia induction was carried out with propofol 1.5-2.0 mg· kg^-1 , vecuronium 0.08 mg/kg, remifentanil 2-4 μg· kg^-1 , and which was followed by LMA ventilation .Anesthesia was maintained by infusion of propofol 4 mg· kg-1 · h^-1 and remifentanil 8 μg· kg-1 · h^-1 .Continuous non-invasive and invasive BP and HR were monitored .Result BP and HR dring anesthetic induction and operation were significantly reduced than those before anesthesia （P〈0.05）.BP and HR were slightly increased during LMA insertion and opera-tion, but with no statistical difference （P〉0.05）.Conclusion Propofol-remifentanil anesthesia with LMA ventilatin can be used safely and effectively in abdominal aortic aneurysm undergoing EVGE .