全麻下不同体位对行喉罩辅助通气择期手术患者血流和呼吸动力学的影响

Effects of Different Positions under General Anesthesia on Hemodynamics and Respiratory Dynam- ics in Patients Undergoing Laryngeal Mask Airway Assisted Ventilation

【目的】探讨全身麻醉下截石位和平卧位对行喉罩辅助通气择期手术患者血流动力学、呼吸动力学及不良反应的影响。【方法】80倒择期手术患者，根据手术体位不同分为截石位组和平卧位组。记录两组麻醉诱导前（T1）、喉罩置入1min（T1）、30min（T2）、60min（T3）、拔出喉管时（T4）各时间点血流动力学及T1、T2、T3时呼吸动力学指标变化和术中不良反应发生情况。【结果】两组在T2时心率（HR）和平均动脉压（MAP）显著低于T0时（P〈0．05），两组同一时间点HR和MAP比较差异无显著性（P〉0．05）；术中随时间推移两组吸气峰压、吸气平台压、呼气峰流速、吸气阻力、呼气阻力和呼吸做功均逐渐升高，吸气峰流速、呼气末二氧化碳分压（PET CO2）、动态顺应性、静态顺应性均逐渐降低。T2、T3时平卧位组吸气峰压、吸气平台压、吸气阻力、呼气阻力和呼吸做功显著低于截石位组（P〈0．05），T1、T2、T3时平卧位组吸气峰流速、呼气峰流速、动态顺应性、静态顺应性显著高于截石位组（P〈0．05），两组各时间点PETC02相比较差异无显著性（P〉O．05）。两组不良反应发生率比较差异无显著性（P〉0．05）。【结论】全麻下截石位和平卧位行喉罩辅助通气对血流动力学影响比较差异不大，但平卧位下对呼吸动力学影响显著较小，两种体位下均无严重不良反应发生。

[Objective]To investigate the effect of lithotomy position and horizontal position on hemodynam- ics, respiratory mechanics and incidence of adverse reactions in patients with laryngeal mask airway（LMA） assis- ted ventilation under general anesthesia. [Methods]Eighty-eight cases of patients were divided into lithotomy posi- tion group（group A） and horizontal position group（group B）. Changes of hemodynamic parameters before induc- tion of anesthesia （To）, lmin （T2）, 30min （T2） and 60min （T3） after LMA mask insertion and at extubation （T4） were recorded. Changes of respiratory mechanics at T1, T2 and T3 were recorded. [Results]The heart rate （HR） and mean arterial pressure （MAP） at T2 in the two groups were significantly lower than those of T0 （ P〈 0.05） ,there was no significant difference of HR and MAP between the two groups at the same time point （ P 〉0.05）. The peak inspiratory pressure, plateau pressure, peak expiratory flow, inspiratory resistance, expiratory resistance and work of breathing in the two groups increased gradually over time while peak inspiratory flow, ex- piratory end partial pressure of carbon dioxide （PET COs ）, dynamic compliance and static compliance decreased gradually. At T2 and T3, the peak inspiratory pressure, plateau pressure, inspiratory resistance, expiratory resist- ance and work of breathing of the group A were significantly lower than those of the group B （ P 〈0.05）. At T2, T2 and T3, the peak inspiratory flow, peak expiratory flow, dynamic compliance and static compliance of the group A were significantly higher than those of the group B （ P 〈0.05）. There was no significant difference in PET CO2 between the two groups （ P 〉0.05）, and there was no significant difference in the incidence of adverse reac- tions between the two groups （ P 〉0.05）. [Conclusion]Under general anesthesia, both of lithotomy position and horizontal position of LMA ventilation on hemodynamics shows no significant difference between the two positions ,but the effect of horizontal position on respiratory dynamics is significantly less, and there were no serious ad- verse reactions under the two kinds of positions.