SLIPA喉罩全麻复合颈丛神经阻滞在沙滩椅体位锁骨骨折内固定手术中的应用

SLIPA LARYNGEAL MASK GENERAL ANESTHESIA COMBINED WITH CERVICAL PLEXUS BLOCK FOR INTERNAL FIXATION OF BEACH-CHAIR FRACTURE OF CLAVICLE

目的观察SLIPA喉罩全麻复合颈丛神经阻滞在沙滩椅体位锁骨骨折内固定手术中的应用效果。方法选择择期行锁骨骨折复位内固定手术病人48例,随机分为SLIPA喉罩组(S组)和气管插管组(G组),各24例。两组均采用全麻复合颈丛神经阻滞,S组采用喉罩通气,G组采用气管导管通气。记录入室5min后(T0)、颈丛神经阻滞成功后15min静脉麻醉诱导前(T1)、喉罩或气管导管插入即刻(T2)、拔除喉罩或气管导管前(T3)、拔除后即刻(T4)5个时点的平均动脉压(MAP)、心率(HR)。监测置入喉罩前(或插管前)、置入喉罩后(或插管后)30min、插管后1h动脉血酸碱度(pH值)、动脉血二氧化碳分压(PaCO2)、动脉血氧饱和度(SaO2)、气道压峰值(PAW)。观察两组病人拔管后不良反应。结果 G组T2和T4时间点的MAP和HR均高于T1(F=10.682、26.713,P<0.05);与S组比较,G组T2和T4时间点的MAP和HR均明显升高(t=2.162~2.690,P<0.05);两组各时点的PAW、PaCO2在体位改变后均在正常范围。拔管后G组有6例发生呛咳;S组有3例诉咽干,2例诉胃胀气;两组均有1例拔管时出现渗血,两组不良反应发生率比较差异无显著性(P>0.05)。两组均无反流误吸发生。结论 SLIPA喉罩全麻复合颈丛神经阻滞用于沙滩椅体位锁骨骨折内固定手术,可取得与插管全麻相同的麻醉效果,但随使用时间延长密闭性有降低趋势。

Objective To observe the clinical effect of SLIPA laryngeal mask general anesthesia（GA）combined with cervical plexus block（CPB）for internal fixation of beach-chair fracture of clavicle. Methods Forty-eight patients with fracture of clavicle scheduled for undergoing internal fixation were selected and evenly randomized to SLIPA laryngeal mask（group S）and tracheal intubation（group G）.The mean arterial pressure（MAP）and heart rate（HR）at five time points-five minutes after entering operating room（T0）,15 min after cervical plexus block,and before intravenous anesthesia induction（T1）,immediately after laryngeal mask or endotracheal intubation（T2）,before removing laryngeal mask or tracheal tube（T3）and immediately upon removing laryngeal mask or tracheal tube（T4）-were recorded.Artery blood pH,arterial partial pressure of carbon dioxide（PaCO2）,arterial oxygen saturation（SaO2）and peak airway pressure（PAP）were detected before inserting the laryngeal mask or intubation,30 minutes and one hour after inserting the mask or intubation.Adverse reactions after extubation in the patients were observed. Results In group G,the MAP and HR at T2 and T4were higher than that in T2（F=10.682,26.713;P〈0.05）.Compared with group S,the MAP and HR at T2 and T4in group G were significantly higher（t=2.162-2.690,P〈0.05）.PAW and PaCO2,in both groups,were in the normal range at each time point after the change of body position.As for adverse reactions after extubation,bucking was recorded in six patients of group G,and in group S,three patients said dry throat,two complained of gastric distension.One case in each group was found blood oozing at removing the tube.The difference in incidence of untoward reactions between the two groups was not significant（P〉0.05）.There was no reflux aspiration was recorded in patients of both groups. Conclusion SLIPA laryngeal mask anesthesia combined with cervical plexus block for internal fixation of beach-chair fracture of clavicle can achieve the same effectiveness as intubation general anesthesia,however,with the extension of the time of use,the tightness of the laryngeal mask may decrease.