经插管型喉罩清醒气管插管对高血压患者应激反应的影响

Effect of awake tracheal intubation with intubating larynegeal mask airway on stress responses of hypertensive patients

目的 评价经插管型喉罩（ILMA）清醒气管插管对高血压患者应激反应的影响.方法 择期全麻下行腹部手术的高血压患者60例,年龄45 ～ 64岁,BMI 20.3～27.5 kg/m2,ASA分级Ⅱ或Ⅲ级.采用随机数字表法分为2组（n=30）：直视喉镜组（D组）和ILMA组（I组）.于表面麻醉后3min（T1）、D组直视喉镜暴露会厌及声门或I组置入ILMA（T2）、气管插管完成即刻（T3）、气管插管后血流动力学变化幅度最大时（T4）和气管插管完成后5 min（T5）时记录MAP和HR,并取血标本,采用放射免疫法测定血浆肾上腺素浓度.记录首次气管插管成功情况.结果 与T1时比较,D组T2～4时MAP、HR和血浆肾上腺素浓度升高（P＜0.01）,I组其余时点上述指标差异无统计学意义（P＞0.05）;与D组比较,I组T2-4时MAP、HR和血浆肾上腺素浓度降低（P＜0.01）,首次插管成功率差异无统计学意义（P＞0.05）.结论 经ILMA行清醒气管插管未诱发强烈的应激反应,有助于避免脑血管意外的发生,提高高血压患者清醒气管插管的安全性.

Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway （ILMA） on stress responses of hypertensive patients.Methods Sixty hypertensive patients,aged 45-64 yr,with body mass index of 20.3-27.5 kg/m2,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective abdominal surgery under general anesthesia,were divided into 2 groups （n=30 each） using a random number table：direct laryngoscope group （group D） and ILMA group （group I）.At 3 min after topical anesthesia （T1）,while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I （T2）,immediately after completion of intubation （T3）,when the maximum change in hemodynamics after intubation appeared （at about 15 s after tracheal tubes were placed,T4）,and at 5 min after completion of intubation （T5）,mean arterial pressure （MAP） and heart rate （HR） were recorded,and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded.Results Compared with the parameters at T1,the MAP,HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D （P〈0.01）,and no significant change was found in the parameters mentioned above at the other time point in group I （P〉0.05）.Compared with group D,the MAP,HR and plasma epinephrine concentrations were significantly decreased at T2-4 （P〈0.01）,and no significant change was found in the success rate of intubation at first attempt in group I （P〉0.05）.Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents,thus increasing the safty of awake tracheal intubation in hypertensive patients.