SLIPA喉罩在高原气道高反应性患者全麻苏醒期的应用研究

Application of SLIPA Laryngeal Mask Airway in Plateau Airway Hyper-responsiveness in Patients during Anesthesia Recovery Period

目的研究高原气道高反应性患者全麻苏醒期深麻醉下拔除气管导管-SLIPA喉罩替代通气对气道及心血管反应的影响。方法收集2014年1月至2014年11月ASA分级Ⅱ或Ⅲ级,经肺功能检查有气道高反应性的择期手术患者60例,将患者随机分为保留气管导管通气组(T组)和深麻醉下拔除气管导管-SLIPA喉罩替代组(L组),每组30例。比较2组麻醉诱导前、拔除气管导管或喉罩前吸痰时、拔除气管导管或喉罩即刻、拔除气管导管或喉罩1 min、3 min和5 min时的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SPO2)和呼吸末二氧化碳分压(Pa CO2)的变化;比较患者从自主呼吸恢复至拔除气管插管或喉罩后5min内的呛咳、喘鸣、憋气、气道压升高、不能耐管等气道反应的情况。结果 T组患者清醒拔除气管导管前后各时点MAP、HR较术前明显升高(P<0.05),L组患者清醒拔除喉罩后上述指标变化差异无统计学意义(P>0.05),患者深麻醉下拔除气管导管-SLIPA喉罩替代通气过程MAP、HR无明显变化(P>0.05)。L组中重度呛咳、喘鸣、憋气、气道压升高、不能耐管发生率低于T组(P<0.05)。结论术毕深麻醉下拔除气管导管-SLIPA喉罩替代通气能降低气道高反应性患者气道应激反应、维持血流动力学稳定,提高全身麻醉术后苏醒质量。

Objective To study the effect of tracheal extubation combined SLIPA laryngeal mask airway ventilation during recovery from deep anesthesia on airway and cardiovascular responses of hyperresponsiveness patients. Methods Sixty patients, ASA grade II- III by pulmonary function tests, diagnosed of airway hyperresponsiveness between 2014 January and 2014 November were recruited for the study, and randomly divided into l^acheal catheter ventilation group （group T） and the removal of - SLIPA trader deep anesthesia laryngeal mask instead of group （group L）, with 30 patients in each group. The mean arterial pressure （MAP）, heart rate （ HR ）, pulse oxygen saturation （SP02） and end expiratory carbon dioxide into two pressure （PaCO2） changes of two groups before induction of anesthesia, removal of the endotracheal tube or laryngeal mask airway Sputum suction time, before removal of the endotracheal tube or laryngeal mask, mean arterial immediate removal of the endotracheal tube or laryngeal mask I min, 3 min and 5 min were compared; in addition, coughing, wheezing, shortness of breath, airway pressure, and airway resistance situations from the spontaneous breathing recovery to endotracheal intubation or laryngeal mask after 5 rnin were analyzed. Results MAP, HR was significantly higher in patients of group T at each time point than that before operation （P 〈 0.05 ）. There was no statistical significance of patients awake of removing laryngeal mask airway changes （P 〉 0.05 ）. There was no significant change of MAP, HR in patients under deep anesthesia extubation - SLI- PA laryngeal mask instead of ventilation process （P 〉 0.05 ）. The severe cough, wheezing, shortness of breath, airway pressure, the failure incidence is lower in group L than that of group T （P 〈 0.05 ）. Condusion Surgery under deep anesthesia extubation - SLIPA laryngeal mask instead of Ventilation can reduce airway hyperresponsiveness and airway stress response, maintain the stability of hemodynamics, improve the quality of recovery after general anesthesia.