可弯曲喉罩、普通喉罩和双管喉罩用于全麻乳腺手术的临床研究

Clinical research on the use of flexible laryngeal mask, classic laryngeal mask and supreme laryngeal mask in breast surgery under general anesthesia

目的对可弯曲喉罩、普通喉罩以及双管喉罩用于全麻乳腺手术的安全性进行随机对照研究。方法拟行全麻乳腺手术的患者60例，美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级，年龄27岁～77岁，参照随机数字表法将患者随机分为3组（每组20例）：可弯曲喉罩组（A组）、普通喉罩组（B组）及双管喉罩组（C组）。常规麻醉诱导后，经口置入喉罩，记录麻醉诱导前（基础值）、喉罩置入前即刻、喉罩置入即刻及喉罩置入后1、2、3、5、10min的心率（heart rate，HR）、血压（blood pressure，BP）和脑电双频指数（bispectral index，BIS），观察患者的血流动力学变化及其并发症。结果3组患者均顺利完成喉罩置入，一次置入成功率均高于90％，插管时间短（均〈1min）。麻醉诱导后，3组患者BIS均显著降低[A组（93±5）VS（39±7），B组（96±3）vs（39±9），C组（95±5）vs（39±9），P〈0．05]，A组BP显著降低[收缩压（systolic blood pressure，SBP）（134±13）mmHgVS（109±12）mmHg（1mmHg=0．133kPa），舒张压（diastolic blood pressure，DBP）（77±10）mmHg vs（64±9）mmHg，平均动脉压（mean artery pressure，MAP）（90±11）mmHg vs（74±9）mmHg，P〈0.05]，B组患者HR和BP均未显著降低，C组患者HR和BP均显著降低[HR（77±10）次／min vs（68±9）次／min，SBP（127±28）mmHg vs（107±15）mmHg，DBP（72±14）mmHg vs（58±11）mmHg，MAP（85±15）mmHg vs（70±10）mmHg，P〈0．05]。在喉罩置入和拔除期间，血流动力学平稳。麻醉诱导、喉罩置入期间，3组各项指标差异无统计学意义，但是A组患者术后并发症发生率低。结论普通喉罩、双管喉罩和可弯曲喉罩插管成功率高、血流动力学平稳，能够有效地减轻插管及拔管的血流动力学反应。较之普通喉罩和双管喉罩，可弯曲喉罩可以降低插管及拔管并发症。

Objective Randomized controlled research on the safety of the use of flexible laryngeal mask, classic laryngeal mask and Supreme laryngeal mask in breast surgeries under general anesthesia. Methods Sixty ASA Ⅰ-Ⅱ patients aged 27 y-77 y weighing 51 kg-82 kg scheduled for breast surgery under general anesthesia were randomly divided into 3 groups （n=20）, according to random number table： flexible laryngeal mask group （group A ）, classic laryngeal mask group （group B ） and Supreme laryngeal mask group （group C ）. After induction of anesthesia, laryngeal mask insertion was performed, respectively. Noninvasive blood pressure （BP）, heart rate （HR） and bispectral index （BIS） were recorded at the time before induction, the time before and just the time of laryngeal mask insertion, at 1,2,3,5,10 min after laryngeal mask insertion was complete. Observe the hemodynamic response and complications of laryngeal mask insertion. Results Patients of three groups had high one-time success rate above 90%, and short intubation time（〈1 min）. BIS of three groups all decreased significantly[group A （93±5） vs （39±7）, group B （96±3） vs （39±9） ,group C （95±5） vs （39±9）, P〈0.05]. In group A, BP was significantly decreased after induction [systolic blood pressure （SBP）（134±13） mmHg vs （109±12） mmHg （1 mmHg=0.133 kPa）, diastolic blood pressure （DBP） （77±10） mmHg vs （64±9） mmHg, mean artery pressure （MAP） （90±11） mmHg vs （74±9） mmHg, P〈0.05]. In group B, there was no significant change in BP and HR. While in group C, there was significant change in HR and BP [HR （77±10） bpm vs （68±9） bpm, SBP （127±28） mmHg vs （107±15） mmHg, DBP（72±14） mmHg vs （58±11） mmHg, MAP（85±15） mmHg vs （70±10） mmHg, P〈0.05 ]. Insertion and extubation of laryngeal mask didn＇t cause violent hemodynamic responses. There were no significant differences among the hemodynamic responses of three groups, during the period of induction of anesthesia and laryngeal mask insertion. And the intubation time, recovery time and extubation time were not different among three groups. There were less complications of intubation and extubation observed in group A, compared with other two groups. Conclusions Flexible laryngeal mask, classic laryngeal mask and Supreme laryngeal mask can all prevent hemodynamic responses to intubation, and flexible laryngeal mask has advantage in reducing complications produced by intubation than other two kinds of laryngeal mask.