可弯喉罩应用于鼻窦炎患者鼻内镜手术的回顾性队列研究

Flexible laryngeal mask for nasal endoscopic surgery in patients with sinusitis:A one-year retrospective cohort study

目的探讨可弯喉罩在鼻窦炎患者鼻内镜手术全身麻醉中的应用。方法选择2017年1月~2018年1月行鼻内镜手术的成年非肥胖鼻窦炎患者1381例,分为插管组和喉罩组,共匹配出35对。记录入室(T1)、插管后(T2)、手术开始(T3)、拔管时(T4)的血流动力学指标、脉搏氧饱和度;插管后、手术开始5分钟、手术开始30分钟和手术结束时气道峰压;术中麻醉药用量;拔管时间;麻醉恢复室入室和出室评分、不良事件。结果喉罩组T2、T3和T4时间点的平均动脉压、心率以及术中瑞芬太尼使用量、拔管时间和拔管时呛咳发生率低于插管组,入室评分高于插管组,差异有统计学意义(P<0.05),而脉搏氧饱和度和出室评分,差异无统计学意义。结论可弯喉罩用于非肥胖鼻窦炎患者的鼻内镜手术是安全有效的。

OBJECTIVE To evaluate the application of flexible laryngeal mask airway(FLMA) for nasal endoscopic surgery in adult patients with sinusitis.METHODS A total of 1381 non-obeseadult patients with sinusitis undergoing endoscopic surgery were selected from January 2017 to January 2018 in our hospital and were divided into endotracheal tube group(group ETT,n=35) and laryngeal mask airway group(group LMA,n=35).There were 35 matches with propensity score matching module.The hemodynamic indicators(mean arterial pressure,MAP and heart rate,HR) and pulse oxygen saturation(SpO2) at entry(T1),after intubation(T2),at the beginning of surgery(T3) and at extubation(T4) were recorded.The peak inspiratory pressure(PIP) after intubation,5 min after the operation,30 min after the operation and at the end of the operation,extubation time,dosage of anesthetics,scores at entering and leaving postanesthesia care unit(PACU) and adverse incidents were observed.RESULTS In LMA group,MAP and HRat T2,T3,T4;the dosage of remifentanil;extubation time and the incidence of cough reflex during extubation were significantly less than those of ETT group(P<0.05).The score at entering PACU was remarkably higher in group LMA than that of group ETT(P<0.05).But there was no statistically significant difference in SpO2 and score at leaving PACU(P>0.05) between the two groups.CONCLUSION The FLMA is safe and effective for nasal endoscopic surgery in non-obese adultpatients with sinusitis.