面部整形手术麻醉方案的可行性研究

Comparasion of different anesthesia approaches in facial plastic surgery

目的探讨不同麻醉方案在面部整形手术中的应用效果。方法将300例自愿实施面部整形手术的患者随机分为静脉麻醉组(VA组)、口咽通气道组(OP组)、喉罩组(LM组)各100例,VA组静脉麻醉后开始作局部浸润麻醉,OP组及LM组插入口咽通气道或喉罩后开始作局部浸润麻醉。记录患者麻醉前(T0)、诱导结束或口咽通气道/喉罩置入后(T1)、苏醒睁眼时(T2)的平均动脉压(MAP)、心率、血氧饱和度(SpO_2)的变化,并记录术中丙泊酚用量、苏醒时间、术中体动例数、SpO_2低于95%例数、术中辅助呼吸例数、术后咽喉部疼痛例数、术后恶心呕吐例数以及麻醉诱导时麻醉医师心理不安全感例数,比较各级的上述指标。结果 3组患者T0、T1、T2时MAP、心率组间比较差异均无统计学意义(P>0.05)。在T0及T2时点3组之间的SpO_2比较差异无统计学意义,但在T1时点VA组SpO_2较OP组及LM组低(P均<0.05)。VA组与OP组及LM组相比,丙泊酚用量较少,患者苏醒时间较短,差异均有统计学意义(P均<0.05);SpO_2低于95%例数、需要辅助呼吸例数、术中体动例数以及麻醉诱导期间麻醉医师心理不安全感例数,VA组均多于OP组及LM组,差异均有统计学意义(P均<0.05);术后咽喉部疼痛、术后恶心呕吐例数3组间比较差异均无统计学意义(P均>0.05);OP组各监测指标与LM组相比差异均无统计学意义(P均>0.05)。结论置入口咽通气道或喉罩能较好解决静脉麻醉对面部整形手术患者呼吸道的梗阻和呼吸抑制问题,提高麻醉安全性,其中口咽通气道比喉罩更简便实用。

Objective To compare the effects of different anesthesia approaches applied during facial plastic surgery.Methods A total of 300 patients who volunteerily underwent facial plastic surgery were randomly divided into the intravenous anesthesia(VA group,n = 100),oropharyngeal airway(OP group,n =100) and laryngeal mask groups(LM group,n = 100).In the VA group,local infiltration anesthesia was performed after intravenous anaesthesia,and local infiltration anesthesia was delivered after the placement of oropharyngeal airway or laryngeal mask in the OP and LM groups.The changes of the mean arterial pressure(MBP),heart rate(HR) and pulse oxygen saturation(SpO_2) were observed before anesthesia(T0),after anesthesia induction or placement of oropharyngeal airway/laryngeal mask(T1),and during resuscitation with eyes open(T2),respectively.Intraoperative dosage of propofol,resuscitation time,number of patients with intraoperative body movement,number of patients with SpO_2< 95%,number of patients with assisted breathing,number of patients with postoperative throat pain,number of patients with postoperative nausea and vomiting and number of anesthesiologists presenting with psychological insecurity were recorded and statistically compared among three groups.Results No significant difference was noted in MAP and HR at T0,T1 and T2 among the three groups(all P > 0.05).No significant difference was observed in the SpO_2 at T0 and T2 among the three groups(all P > 0.05),whereas the SpO_2 in the VA group was significantly lower than those in the OP and LM groups at T1(both P < 0.05).In the VA group,the dosage of propofol was significantly less and the resuscitation time was significantly shorter compared with those in the OP and LM groups(all P < 0.05).In the VA group,the number of patients with SpO_2< 95%,number of patients with assisted breathing,number of patients with intraoperative body movement and number of anesthesiologists presenting with psychological insecurity were significantly higher than those in the OP and LM groups(all P < 0.05).No statistical significance was documented in the number of patients with postoperative throat pain and those presenting with postoperative nausea and vomiting among the three groups(all P > 0.05).No significant difference was noted in all parameters between the OP and LM groups(all P > 0.05).Conclusions Placement of oropharyngeal airway and laryngeal mask can effectively resolve the problems of respiratory obstruction and respiratory depression in patients undergoing facial plastic surgery induced by intravenous anesthesia and improve the safety of intravenous anesthesia.The oropharynx airway is simpler and more practical than the laryngeal mask airway.