喉罩应用于瑞芬太尼静脉麻醉下气管狭窄的介入手术

Effect of LMA in intervention for airway stenosis under remifentanil intravenous anesthesia

目的观察瑞芬太尼维持麻醉下喉罩在支气管镜下气管狭窄介入手术的应用情况。方法选择限期或急诊行气管狭窄介入手术患者29例,瑞芬太尼和异丙酚麻醉下置入喉罩,观察整个麻醉和手术过程中的平均动脉压(MAP)、心率(HR)、气道压变化、清醒时间和拔管时间,以及是否存在通气不良、缺氧、呛咳、体动及咽痛等其他不良反应。结果插管前后平均动脉压明显降低,分别为(85.8±21.6)mm Hg和(78.0±20.3)mm Hg,P<0.05;心率无明显变化,分别为(89.9±25.4)次/min和(92.1±21.7)次/min。拔管期间均未见平均动脉压和心率明显变化,治疗前后气道压明显降低,分别为(22.5±03.81)cm H2O和(19.90±3.00)cm H2O,清醒时间和拔管时间平均在(13.40±4.39)min。1例因患者气道压过高,超过喉罩的漏气压发生漏气,12人拔管后感觉咽痛。结论瑞芬太尼维持麻醉下喉罩应用于气管狭窄介入手术心血管刺激小、通气效果良好,适合高风险的患者,但仍有漏气的风险及咽痛的不适。

Objective To evaluate the effect of laryngeal mask airway （LMA）in intervention for airway stenosis under remifentanil maintenance.Methods 29 patients undergoing intervention with LMA were maintained with remifentanil and propofol.During the periond of anesthesia and intervention,mean arterial pressure,heart rate,peak of airway pressure,the time for awake and extubation were recorded. Results MAP reduced from （85.8 ±21.6）mmHg to （78.0 ±20.3）mmHg after intubation,P 〈0.05. MAP and HR had no significant change during extubation.The peak of airway pressure were reduced from （22.5 ±3.81）cm to （19.9 ±3.00）cm H2 O.The awake and extubation time was （13.4 ±4.39）min.In one case,the LMA were leaked,because the airway pressure were beyond the leakage pressure,and 12 cases got sour throat after extubation.Conclusion LMA can be effectively used in intervention for airway stenosis under remifentanil maintenance with mild airway and circulation stimulation,but still have the risks of leakage and sour throat.