喉罩全麻在老年动脉瘤介入栓塞术中的应用

The clinical application of laryngeal mask anesthesia for intracranial aneurysm embolization in elderly pations

目的探讨喉罩全麻在老年颅内动脉瘤介入栓塞术中的临床应用。方法以2018年1月至2020年1月的60例择期全麻下行颅内动脉瘤介入栓塞术的老年患者为研究对象,60例患者随机分为两组。麻醉诱导后,分别置入喉罩或插管进行机械通气,两组给予同样的麻醉方法,诱导后均泵注3μg/(kg·h)瑞芬太尼、3~5mg/(kg·h)丙泊酚及间断静脉注射顺式阿曲库铵维持麻醉深度。记录麻醉诱导前(T0)、置入喉罩或插管后即刻(T1)、置入喉罩或插管后5min(T2)、股动脉穿刺时(T3)、手术结束时(T4)、拔除喉罩或拔除气管导管后5min(T5)的平均动脉压(MAP)、收缩压(SBP)、舒张压(DBP)和心率(HR)值;记录恶心呕吐、呛咳、咽痛、声音嘶哑及呼吸抑制等不良反应的例数。结果两组患者在性别、年龄、手术时间等的比较无统计学差异(P>0.05)。两组患者麻醉诱导前(T0)的SBP、DBP、MAP及HR无明显差异(P>0.05)。两组在喉罩或插管后即刻(T1)、置入喉罩或插管后5min(T2)、拔除喉罩或拔管后5min(T5)的SBP、DBP、MAP及HR比较差异有统计学意义(P<0.05),L组低于E组;而两组患者切皮时(T3)、手术完毕时(T4)的SBP、DBP、MAP及HR无明显差异(P>0.05)。两组患者苏醒期恶心呕吐、呛咳、咽痛、声音嘶哑及呼吸抑制发生率的差异具有统计学意义(P<0.05)。结论喉罩全麻应用于老年颅内动脉瘤介入栓塞手术患者,能够维持血流动力学平稳性,降低术中应激反应,减少拔管后恶心呕吐、呛咳、咽痛、声音嘶哑及呼吸抑制,不良反应发生率低,具有一定的临床应用价值。

Objective To explore the clinical application of laryngeal mask anesthesia for intracranial aneurysm embolization in elderly patients.Methods Sixty cases of elderly patients scheduled for intracranial aneurysm embolization who were admitted to hospital between January 2018 and January 2020 were randomly divided into two groups:laryngeal mask anesthesia group(group L)(n=30)and endotracheal intubation anesthesia group(group E)(n=30).After induction of anesthesia,the laryngeal mask airway or endotracheal tube was inserted into mechanical ventilation.Both groups were given same anesthesia method and received intraoperative intravenous infusion of remifentanil[3μg/(kg·h)]and propofol[3~5mg/(kg·h)]and intermittent bolus injection of cisatracurium to maintain the depth of anesthesia.The mean arterial pressure(MAP),the systolic arterial pressure(SPB),the diastolic arterial pressure(DPB)and heart rate(HR)recorded at the time T0(before anesthesia induction),T1(immediately after intubation),T2(5min after intubation),T3(surgery start),T4(surgery finished)and T5(5min after extubation).The incidence of nausea and vomit,cough,sore throat,hoarseness and respiratory depression were recorded.Results There were no difference in the age,gender,operation time between the two groups(P>0.05).At the time of T0,the levels of MAP,SBP,DBP and HR were no difference between the two groups(P>0.05).At the time of T1,T2,T5,the levels of MAP,SBP,DBP and HR in group L were lower than those in the group E,the difference was statistically significant(P<0.05).But there were no significant difference between the two groups at the time of T3,T4(P>0.05).The incidence of nausea and vomit,cough,sore throat,hoarseness and respiratory depression indicated statistical differences between the two groups(P<0.05).Conclusion LMA anesthesia can be safely used in elderly patients for intracranial aneurysm embolization operation,it can maintain hemodynamic stability,lighten intraoperative stress response,and reduce the incidence of nausea and vomit,cough,sore throat,hoarseness and and respiratory depression after extubation.The incidence of of adverse reactin was low.It is worthy of clinic promotion.