I-gel喉罩联合气管插管全身麻醉在老年患者俯卧位胸腰椎手术中的应用

Application of I-gel laryngeal mask combined with tracheal intubation general anesthesia in elderly patients undergoing thoracolumbar operation in prone position

目的探讨I-gel喉罩联合气管插管全身麻醉(全麻)在老年患者俯卧位胸腰椎手术中的临床效果及安全性。方法 60例年龄≥65岁、行俯卧位胸腰椎手术的骨科患者随机均分为I-gel喉罩联合气管导管全麻组(IT组)和单独应用气管导管全麻组(T组)。记录麻醉诱导前(T0)、置入气管导管即刻(T1)、拔除喉罩或气管导管即刻(T2)、拔除喉罩或气管导管后5min(T3)时的MAP、HR、SpO2、血糖和血浆皮质醇水平。记录平卧位置入气管导管后5min(T4)、俯卧位手术开始后30min(T5)和术毕即刻俯卧位(T6)时的气道峰压(Ppeak)和PETCO2。结果 T1~T3时,IT组MAP和HR低于T组(P<0.05)。IT组T1、T2时血浆皮质醇以及T2、T3时血糖水平均低于T组(P<0.05)。T4~T6时IT组Ppeak高于T组(P<0.01)。结论与单独应用气管导管相比,老年患者俯卧位胸腰椎手术全麻中使用I-gel喉罩联合气管导管能更好地维持循环稳定,减少患者应激反应,提高术后苏醒质量。

Objective ： To investigate the clinical effect and safety of application of I-gel laryngeal mask combined with tracheal intubation general anesthesia in elderly patients undergoing thoracolumbar operation in prone position. Methods Sixty patients aged≥ 65 years undergoing thoracolumbar operation in prone position were equally randomized into two groups of IT（using I-gel laryngeal mask combined with tracheal intubation general anesthesia） and T（using tracheal intubation alone）. The MAP, HR, SpO2 and the concentrations of blood glucose and plasma cortisol were recorded at the time points of TO （before induction）, T1 （ tracheal intubation）, T2 （ immediately after removal of laryngeal mask or tracheal tube） and T3（at 5 minutes after T2）. The peak airway pressure （Ppeak） and PETCO2 were recorded at the time points of T4（at 5 minutes after tracheal intubation in supine position）,T5（at 30 minutes after the beginning of operation in prone position） and T6（at the end of operation in prone position）, Results The MAP and HR were lower in group IT than those in group T at T1 to T3（P〈0. 05）. Plasma cortisol at T1 and T2 and blood glucose at T2 and T3 were lower in group IT than those in group T（P〈0. 05）. Ppeak was higher in group IT than that in group T at T4 to T6（P〈0. 01）. Conclusion Compared with tracheal intubation alone,combined＇use of I-gel laryngeal mask and tracheal intubation general anesthesia in elderly patients undergoing thoracolumbar operation in prone position has the advantages of better keeping circulation stabile, reducing the stress response, and improving the quality of recovery from general anesthesia.