插管型喉罩联合气管插管在俯卧位手术患者中疗效观察

胡丰登++朱轶++徐巧丹++王伟++徐象威

[摘要] 目的 探討插管型喉罩（ILMA）联合气管插管在俯卧位手术患者中应用临床效果及安全性。 方法 80例择期需俯卧位手术的患者通过随机数字表法分成两组，气管导管组（ET组）和插管型喉罩组（ILMA组），各40例。ET组患者诱导麻醉后行气管插管，术后各项拔管指征恢复后拔除气管导管。ILMA组患者诱导麻醉后先插入配套喉罩，5 min后气管导管经插管型喉罩置入，术后平卧位后深麻醉下拔除气管导管，留置喉罩，待各项拔管指征恢复后拔除喉罩。记录两组T0（麻醉诱导前），T1（诱导用药后插入喉罩或气管导管前），T2（气管导管插入时），T3（切皮时），T4（术中），T5（拔除气管导管或喉罩时）5个时段的心率（HR）、平均动脉压（MAP）。且观察苏醒期间的苏醒时间（T6）、自主呼吸恢复时间（T7），以及评估苏醒期间的并发症如躁动、恶心呕吐等发生情况。 结果 ILMA组T2、T5时段HR、MAP显著低于ET组（P<0.05）；术后苏醒质量方面，ILMA组T6、T7显著短于ET组（P<0.05），术后呛咳、躁动发生率也显著低于ET组（P<0.05）。 结论 俯卧位手术的患者麻醉时采用插管型喉罩全麻的血流动力学更稳定，术后麻醉苏醒质量更高，安全性及可控性好。

[关键词] 插管型喉罩；气管导管；俯卧位；全身麻醉

[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2017）29-0098-04

Observation on curative effect of intubation laryngeal mask combined with tracheal intubation in patients with the prone position surgery

HU Fengdeng1 ZHU Yi1 XU Qiaodan1 WANG Wei2 XU Xiangwei3

1.Department of Anesthesiology， the First People's Hospital of Yongkang Cityin Zhejiang Province， Yongkang 321300， China； 2.Department of Neurosurgery， the First People's Hospital of Yongkang City in Zhejiang Province， Yongkang 321300， China； 3.Department of Clinical Pharmacy， the First People's Hospital of Yongkang City in Zhejiang Province， Yongkang 321300， China

[Abstract] Objective To investigate the clinical effect and safety of intubation laryngeal mask（ILMA） combined with tracheal intubation in patients with prone position surgery. Methods 80 patients needing elective prone position surgery were divided into two groups by random number table method， including tracheal tube group（ET group） with 40 cases and intubation laryngeal mask（ILMA group） with 40 cases. The patients in ET group underwent tracheal intubation after induction of anesthesia. And their tracheal tube was removed after the recovery of postoperative extubation indications. The matched laryngeal mask was inserted into the patients of ILMA group， and 5min later the tracheal catheter was inserted through the intubation laryngeal mask. The tracheal tube was removed and the laryngeal mask was indwelled under deep anesthesia in the postoperative supine position. And the laryngeal mask was removed after the recovery of extubation indications. The heart rate （HR） and mean arterial pressure （MAP） of the two groups at T0（before anesthesia induction）， T1（after induction of medication and before inserting the laryngeal mask or tracheal tube）， T2 （the time when the tracheal tube was inserted）， T3 （when cutting the skin）， T4 （intraoperation）， T5 （the time when tracheal tube and laryngeal mask were removed） were recorded. The awakening time（T6） and spontaneous breathing recovery time （T7） during waking were observed. The occurrence of complications such as restlessness， nausea and vomiting during the awakening period was assessed. Results The levels of HR and MAP in the ILMA group at T2 and T5 were significantly lower than those in ET group（P<0.05）. The quality of waking in ILMA group at T6 and T7 was significantly lower than that in the ET group（P<0.05）. The incidence of cough and restlessness in the ILMA group was significantly lower than that of ET group（P<0.05）. Conclusion The hemodynamics of general anesthesia with intubation laryngeal mask is more stable during anesthesia in patients with prone position， and the quality of anesthesia is higher， and the safety and controllability are better.endprint