无肌松联合胃镜喉罩在肝硬化患者内镜静脉曲张套扎术中的应用

Efficacy of Non-muscle Relaxation Combined with Gastroscopic Laryngeal Mask Airway for Patients with Liver Cirrhosis Undergoing Endoscopic Esophageal Variceal Ligation

目的评价无肌松联合胃镜喉罩在肝硬化患者内镜静脉曲张套扎术(EVL)中的应用效果。方法选取2021年12月至2022年8月于郑州大学第一附属医院接受择期EVL的肝硬化患者80例,采用随机数字表法分为对照组(40例)和观察组(40例)。两组均接受胃镜喉罩通气,其中对照组接受肌松药常规静脉诱导。记录喉罩置入成功情况、套扎器置入成功情况和置入时间;记录术中低血压、心动过缓、低氧血症的发生情况;记录喉罩放置到位后1 min、套扎器置入食管入口即刻和术毕即刻的气道峰压和气道密封压;记录拔管时间、麻醉恢复室(PACU)停留时间;记录术后6 h内咽痛和恶心呕吐及乏力发生情况;记录术后内镜医师及患者的满意度评分。结果两组喉罩置入成功率、套扎器置入成功率、术中低血压、心动过缓、术后6 h内咽痛和恶心呕吐发生率、内镜医生满意度评分比较,差异无统计学意义(P>0.05)。两组气道峰压时间效应、气道密封压组间效应、时间效应有统计学意义(P<0.05)。观察组拔管时间、PACU停留时间缩短,乏力发生率低,患者满意度高(P<0.05)。两组术中均未见低氧血症发生。结论无肌松联合胃镜喉罩用于内镜EVL肝硬化患者具有拔管早、乏力发生率低、患者满意度高等优势。

Objective To evaluate the application effect of non-muscle relaxation combined with gastroscopy laryngeal mask in endoscopic variceal ligation(EVL)in patients with liver cirrhosis.Methods Eighty patients with liver cirrhosis who underwent elective EVL at the First Affiliated Hospital of Zhengzhou University from December 2021 to August 2022 were selected and randomly divided into control group(40 cases)and observation group(40 cases)using the random number table method.Both groups received gastroscopy laryngeal mask ventilation,while the control group received routine intravenous induction with muscle relaxants.The success of laryngeal mask insertion,the success of ligation device insertion,and the insertion time were recorded.The occurrence of intraoperative hypotension,bradycardia,and hypoxemia were recorded.The peak airway pressure and airway sealing pressure 1 minute after the placement of the laryngeal mask,immediately after the placement of the ligature at the esophageal inlet,and immediately after the surgery were recorded.The time of extubation and the duration of stay in the anesthesia recovery room(PACU).Record the occurrence of pharyngeal pain,nausea,vomiting,and fatigue within 6 hours after surgery were recorded.The satisfaction scores of postoperative endoscopists and patients were recorded.Results There was no statistically difference in the success rates of laryngeal mask insertion,ligation device insertion,intraoperative hypotension,bradycardia,incidence of pharyngeal pain and nausea and vomiting within 6 hours after surgery,and satisfaction scores of endoscopists between the two groups(P>0.05).The time effect of peak airway pressure,inter group effect and time effect of airway sealing pressure were statistically significant between the two groups(P<0.05).The observation group had shorter extubation time and PACU stay time,lower incidence of fatigue,and higher patient satisfaction(P<0.05).No hypoxemia was observed during surgery in both groups.Conclusion The combination of muscle free relaxation and gastroscopy laryngeal mask has the advantages of early extubation,low rate of fatigue,and high patient satisfaction in patients with endoscopic EVL cirrhosis.