Supreme^(TM)喉罩在喉癌患者气管切开术中应用的可行性和安全性研究

Study on the Feasibility and Safety of LMA Supreme^(TM) Used in Tracheotomy for Laryngeal Cancer Patients

目的探讨Supreme TM喉罩在喉癌患者气管切开术中应用的可行性和安全性,以及对患者血流动力学、SPO2以及血糖的影响,评价SupremeTM喉罩在喉癌手术中的应用价值。方法选择50例ASAⅠ~Ⅲ级的男性喉癌Ⅱ、Ⅲ期择期手术病人,随机分为喉罩麻醉气管切开组(L组)和局部浸润麻醉气管切开组(T组),每组25例。观察入室时(T1)、气管切开开始1 min(T2),气管导管置入1 min(T3)以及喉癌根治术后30 min(T4)4个时点的MAP、HR、SPO2变化以及血糖水平,同时统计气管切开所用时间。结果 T组在T2(112.33±10.76vs75.05±6.34)、T3(119.45±9.87vs75.37±6.56)的MAP显著高于L组,T组在T2(115.68±10.45vs80.32±7.23)、T3(110.56±9.94vs83.43±6.68)的HR显著高于L组,T组在T3(8.56±1.54vs6.23±1.32)、T4(9.07±1.37vs4.24±0.54)血糖高于L组,T组所用气管切开时间高于L组(19.3±2.9vs14.5±3.1)。结论与局部浸润麻醉下气管切开置入气管插管通气相比,SupremeTM喉罩麻醉下气管切开对患者血流动力学干扰小,导致的血糖升高反应轻,同时能有效保证通气,缩短手术时间。

Objective To evaluate the application value of LMA Supreme TM in laryngeal cancer surgery by investigating the feasibility and safety of LMA SupremeTM used in tracheotomy for laryngeal cancer patients and its effect on the hemodynamlcs, SPO2 and blood sugar of the patients. Methods Fifty male cases with laryngeal cancer stage Ⅱ or Ⅲ, ASA Ⅰ - Ⅲ grade, undergoing selective tracheotomy surgery were selected and randomly divided into 2 groups, Laryngeal mask anesthesia tracheotomy with LMA SupremeTM group （L group） and Local infiltration anesthesia tracheotomy group （T group）, each group with 25 cases. Changes of MAP, HR and SPO2 and the blood glucose levels of the patients were observed at the time of entering the operating room （T1）, lmin after tracheotomy （T2）, lmin after tracheal catheter （T3） and 30min after laryngeal cancer radical surgery（T4）. And the time spent on the tracheotomy wagrecorded. Results The MAP of T group was significantly higher than that of L group at the time point of T2（112.33±10.76 vs. 75.05±6.34） and T3（119.45±9.87 vs. 75.37±6.56）, and HR of the T group was obviously higher than that of L group at the time point of T2 （115.68±10.45 vs. 80.32±7.23）, and T3 （110.56±9.94 vs. 83.43±6.68）; the blood glucose level of T group was higher than that of L group at the time point of T3（8.56±1.54 vs. 6.23±1.32）, and T4（9.07±1.37 vs. 4.24±0.54）. T group＇ spent more time on tracheotomy than L group （19.3±2.9 vs. 14.5±3.1）. Conclusion Compared with local tnfiltration anesthesia tracheotomy, patient with laryngeal mask anesthesia tracheotomy with LMA SupremeTM has more stable hemodynamic, better glycernic levels, and shorter operative time based on ensuring the effective ventilation.