加强型喉罩在急诊神经介入手术的应用研究

Clinical application of reinforced laryngeal mask airway in neurointerventional emergency treatment

目的观察加强型喉罩用于急诊神经介入手术的应用效果。方法全麻下行急诊神经介入手术患者60例,分为气管插管组(T组)和喉罩组(L组)。观察并记录麻醉诱导前(T1)、诱导后(T2)、插入气管插管或喉罩后1 min(T3)、股动脉穿刺时(T4)、手术结束时(T5)以及拔管即时(T6)SBP,HR,SPO2及BIS值;记录苏醒时间,记录Propofol及Remifentanil的用量,记录气管插管或喉罩首次插入成功率和总成功率,记录呛咳、返流误吸、喉痉挛、以及躁动发生情况。结果与T组比较,L组SBP及HR在T3、T6时明显降低(P<0.05)。与T1时点比较,T组SBP及HR在T3、T6时明显升高(P<0.01);L组SBP及HR在T3,T6时差异无统计学意义。与T组比较,L组患者苏醒时间明显缩短(P<0.05);Propofol及Remifentanil用量明显减少(P<0.05);呛咳、躁动发生率明显降低(P<0.05)。而两组各时段SPO2与BIS、气管插管或喉罩首次成功率和总成功率、喉痉挛及反流误吸的发生率差异均无统计学意义。结论加强型喉罩用于急诊神经介入术中,插、拔管期间血流动力学平稳,术后苏醒时间短,不良反应较少。

Objective To observe the clinical effect of reinforced laryngeal mask airway on neurointerventional emergency operation. Methods Sixty patients scheduled for neural interventional treatment under general anesthesia were randomized into two groups ： group T（tracheal intubation）and group L（reinforced laryngeal mask airway）..SBP,.HR, SPO2 and BIS in both group were recorded at different time points as following： immediately before and after anesthesia induction（T1and T2）,.1 min after endotracheal tube placement or laryngeal mask airway insertion（T3）, femoral artery puncture（T4）, the end of the operation（T5） and immediately after extubation（T6）. Emergence time from anesthesia, consumption of propofol and remifentanil, the success rate of first insertion and total insertion were recorded or calculated. Also,.the occurrence of possible adverse effects such as bucking,regurgitation and aspiration,.laryngeal spasm and emergence agitation were recorded..Results Compared with group T, the value of SBP and HR of group L decreased significantly at T3, T6（P〈0.05）. In group T, at the time points T3 and T6, the value of SBP was obviously higher and HR was significantly faster than that at T1（P〈0.01）, while there was no such difference in group L. Compared with group T, the recovery time was significantly shorter（P〈0.05）, and the consumption of propofol and remifentanil,the incidence of postoperative bucking and emergence agitation were reduced obviously in group L,（P〈0.05）, while the value of SPO2 and BIS, the success rate of first insertion and total insertion, along with the incidence of regurgitation and aspiration, laryngeal spasm had no statistically difference between two groups. Conclusion The application of reinforced laryngeal mask airway in neurointerventional emergency treatment can not only maintain the stability of hemodynamics during intubation and extubation, but also shorten recovery time with less adverse effects.