回顾性分析喉罩与气管插管全麻在气管狭窄手术中的临床应用

Retrospective analysis of clinical application of general anesthesia with laryngeal mask or endotracheal intubation in tracheal stenosis surgery

目的回顾性分析喉罩及气管插管全麻在气管狭窄手术中应用的可行性与安全性。方法选取2010-01-01/2019-12-31期间在我院普胸外科接受气管狭窄手术治疗的患者40例,根据气道管理方式不同分为无肌松喉罩全麻组(喉罩组,n=19)和气管内插管全麻组(气管插管组,n=21),分析患者术前一般资料、围术期生命体征、术后恢复情况及住院时间等指标。结果所有患者均在原有麻醉方式下顺利完成手术。两组患者术中呼气末二氧化碳分压(P_(ET)CO_(2))、脉搏血氧饱和度(SpO_(2))<95%发生率、出血量等均无统计学意义(P>0.05);术后恶心呕吐、引流时间、恢复进食时间、自主下地时间、住院时间差异均无统计学意义(P>0.05);与气管插管组比较,喉罩组诱导期血压波动幅度更小,瘤体出血发生率、术后咽喉疼痛及术后声音嘶哑发生率更低(P<0.05)。结论喉罩全麻方式没有增加气管狭窄患者围术期低氧血症风险和术后并发症,降低气道管理所致瘤体出血发生率,减轻患者术后喉部不适;喉罩全麻可作为气管狭窄手术气道管理的一种备选方法之一。

Objective To retrospectively analyze the feasibility and safety of general anesthesia with laryngeal mask or endotracheal intubation anesthesia in tracheal stenosis surgery.Methods A total of 40 patients undergoing tracheal stenosis surgery,from January 1 st,2010 to December 31 st,2019,were divided into the laryngeal mask group(n=19)and the intubation anesthesia group(n=21),according to airway management strategies.The data on preoperative general information,perioperative parameters of vital signs,the condition of postoperative recovery and hospitalization time were analyzed.Results All surgical procedures were completed under the originally planned anesthesia.There was no statistically significant difference between the two groups of patients in intraoperative blood loss,PETCO_(2),the incidence of SpO_(2)<95%and postoperative nausea and vomiting,postoperative drainage duration,postoperative eating recovery time,postoperative off-bed activity time and hospitalization time(P>0.05).Compared with the tracheal intubation group,the laryngeal mask group showed smaller degree of blood pressure fluctuations during the induction period,and the incidence of postoperative throat pain and postoperative hoarseness were statistically lower(P<0.05).Conclusion Although laryngeal mask anesthesia did not increase the risk of perioperative hypoxia and postoperative complications,it could reduce the laryngopharynx discomfort,which can be an alternative for airway management in trachea stenosis surgery.