插管型喉罩预防高血压脑出血患者全麻恢复期拔管反应的效果

Effects of intubating laryngeal mask airway in prevention of extubation responses in patients with hypertensive cerebral hemorrhage during general anesthesia recovery period

目的评价插管型喉罩（ILMA）预防高血压脑出血患者术后恢复期拔管反应的效果。方法选取2012年12月至2014年12月福建医科大学附属泉州第一医院神经外科因高血压基底节区脑出血急诊行开颅血肿清除术的患者120例，年龄47～71岁，格拉斯哥（GCS）昏迷指数评分11～15分，呼吸正常，美国麻醉医师协会（ASA）分级I～Ⅱ级，采用随机数字表法将患者分为气管内插管组和插管型喉罩组，每组60例，比较2组患者术后恢复期拔除气道装置前后的血流动力学变化，以及2组患者术后恢复期拔管反应和呛咳的发生率。结果2组患者的年龄、性别构成比、术前GCS评分、手术时间和术毕到4次成串刺激（TOF）=4的时间差异均无统计学意义（均P〉0．05）。监测2组患者拔除气道装置即刻（T3）、拔除气道装置后1min（T4）、3min（T5）、5rain（T6）的有创动脉平均压（MAP）和心率，气管内插管组在L、T4、L、L的MAP分别为（136±20）、（130±16）、（128±12）、（125±10）mmHg（1mmHg=0．133kPa），心率分另U为（105±11）、（96±8）、（92±7）、（86±6）次／min；插管型喉罩组在L、T4、L、T6的MAP分别为（108±10）、（106±8）、（105±9）、（106±7）mmHg，心率分别为（75±8）、（76±7）、（68±5）、（67±6）次／min；2组患者各对应时间点的MAP和心率比较，差异均有统计学意义（T3：t=10．91、17．20，T4：t=13．72、14．69，T5：t=12．54、13．35，T6：t=13．39、11．27，均P〈0．01）。气管内插管组和插管型喉罩组拔管反应发生率分别为92％和2％，差异有统计学意义（x2=94．05，P〈0．01）；呛咳发生率分别为97％和0，差异有统计学意义（x2=148．69，P〈0．01）。结论与气管内插管比较，使用插管型喉罩早期拔除气管内导管可预防高血压脑出血患者术后恢复期的气管拔管反应及呛咳反射，可避免再次发生脑血管意外。

Objective To evaluate the effects of intubating laryngeal mask airway （ILMA） in prediction of extubation responses in patients with hypertensive cerebral hemorrhage during general anesthesia recovery period. Methods A total of 120 patients with hypertensive cerebral hemorrhage aged 47 - 71 years, with Glasgow Coma Scale （GCS）11 -15 scores and American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ, undergoing craniotomy surgery from December 2012 to December 2014 in the Affiliated First Municipal Hospital of Fujian Medical University were randomly divided into 2 groups （ n = 60） ： tracheal intubation （Group T） and intubating laryngeal mask airway （Group Ⅰ）, by using a random number table. Variations of invasive arterial blood pressure and responses of endotracheal extubation were compared between two groups before and after extubation. Results There were no significant differences in ages, sex ratio, preoperative GCS, operation time and the time from the end of operation to Train of Four stimulation （TOF） becoming to 4 between the two groups. The mean arterial pressure （MAP） at the time point of extubation （ T3 ）, 1 min （ T4 ）, 3 min （ T5 ）, 5 min （ T6 ） after extubation were （ 136 ± 20）, （130 ±16）, （128±12）, （125 ±10） mmHg in Group T, and heart rate（HR） at these four time points were （ 105± 11 ）, （96± 8 ）, （92± 7 ）, （ 86 ± 6） bpm, respectively. While in group I, MAP were （ 108 ± 10）, （106±8）, （105±9）, （106±7） mmHg, and HR were （75±8）, （76±7）, （68±5）, （67±6） bpm, respectively. MAP and HR of the two groups at these four time points had significant differences （T3 ： t = 10.91,17.20; T4： t =13.72,14.69; T5： t =12.54,13.35; T6： t=13.39,11.27; all P〈0.01）. During recovery, the incidences of extubation responses of group T and group I were 92% and 2%, respectively, and the difference had statistically significant （ χ2 = 94. 05, P 〈 0. 01 ）. The incidences of coughing of group T and group I were 97% and O, respectively, and the difference had statistically significant （χ2 = 148. 69, P 〈 0. 01 ）. Conclusion Compared with tracheal intubation, ILMA can decrease the incidence of extubation responses and coughing in patients with hypertensive cerebral hemorrhage during general anesthesia recovery period, and avoid cere-brovascular accidents.