可弯曲喉罩与加强型气管导管在老年高血压患者甲状腺手术中的应用

Application of Flexible LMA and reinforced endotracheal tube in elderly hypertensive patients during thyroidectomy

目的比较Flexible喉罩与加强型气管导管用于老年高血压患者甲状腺手术的效果。方法择期全麻下行甲状腺手术,且术前合并高血压的老年患者60例,年龄65~75岁,ASAⅡ或Ⅲ级,随机均分为两组：Flexible喉罩组（F组）和加强型气管导管组（R组）。静注咪达唑仑0.04mg/kg、芬太尼3μg/kg、丙泊酚1.3~1.8mg/kg、罗库溴铵0.6mg/kg行麻醉诱导。记录麻醉诱导前（T0）、插入Flexible喉罩或气管导管即刻（T1）、插入后1min（T2）、5min（T3）、拔除喉罩或气管导管前（T4）、拔除后1min（T5）、5min（T6）的MAP和HR;测定T0~T3时血浆肾上腺素和去甲肾上腺素浓度;监测术中气道峰压（Ppeak）、PETCO2、F组气道密封压及拔除喉罩或气管导管后不良反应。结果 T1、T2时R组MAP明显高于,HR明显快于T0时和F组,T3时两组MAP明显低于T0时（P〈0.05）。T1、T2时R组肾上腺素及去甲肾上腺素浓度明显高于T0时和F组（P〈0.05）。F组气道密封压为（28±3）cm H2O,两组Ppeak及PETCO2组间组内差异无统计学意义。与F组比较,R组拔除气管导管时呛咳反应及拔管后咽喉痛的发生率均明显升高（P〈0.05）。结论 Flexible喉罩可安全用于老年高血压患者的甲状腺手术,且麻醉相关应激反应及并发症较气管插管低。

Objective To compare the efficacy of the Flexible LMA and reinforced endotrache- al tube in elderly hypertensive patients during thyroidectomy. Methods Sixty ASA Ⅱ or Ⅲ elderly hypertensive patients, aged 65-75 years, undergoing thyroidectomy under general anesthesia were randomly divided into 2 groups： the Flexible LMA group （group F） and the reinforced endotracheal tube group （group R）. MAP and HR were recorded before anesthesia induction （T0）, at the time of inserting the Flexible laryngeal mask or reinforced endotracheal tube （TI）, 1 min （T2） and 5 min （T3） after insertion, before extubation （T4）, and 1 rain （T5） and 5 rain （T6） after extubation. The plasma concentration of epinephrine and norepinephrine were measured at T0-T3. Peak airway pres- sure （Ppeak）, PET CO2. airway seal pressure, and post-extubation complications were recorded. Results Compared with that at T0, MAP was decreased at T3 in groups F and R. MAP and HR were increased at T1 and Tz in group R （P〈0. 05）. MAP and HR were higher at T1, T2, and T4 in group R than those in group F （P〈0. 05）. Compared with those at To and group F, the levels of epineph- rine and norepinephrine were increased at T1 and T2 in group R （P〈0. 05）. The airway seal pressure was （28 ± 3） cm H20 in group F. There was no significant difference in PET CO2 and Ppeak. The inci- dence of choking and sore throat was significantly higher in group R than in group F （P〈0.05）. Conclusion Flexible LMA can be applied safely and effectively to thyroid surgery in elderly hyperten- sive patients, which reduces stress response and post-extubation complications .