喉罩通气全身麻醉在高龄患者髋部手术中的应用

发布时间：2018-04-18 12:29

本文选题：老年人 + 麻醉　；参考：《河北医药》2016年05期

【摘要】：目的探讨在老年患者侧卧位髋部手术中喉罩通气全身麻醉呼吸和循环管理的方法。方法 52例老年髋部手术患者随机分配进入L组(喉罩通气全身麻醉)和T组(气管插管),每组26例。L组采用微泵注射结合静脉推注的慢诱导模式;术中持续静脉泵注丙泊酚和瑞芬太尼维持,根据手术刺激强度复合七氟醚吸入麻醉;体位变动时短时间脱管防止喉罩松动,侧卧位后重新固定螺纹管并确认喉罩位置。观察和记录入室后10 min(T0)、插管(喉罩)前(T1)、插管(喉罩)后1 min(T2)、插管(喉罩)后5 min(T3)、插管(喉罩)后8 min(T4)、切皮(T5)、拔出气管导管或喉罩即刻(T6)的MAP及HR,记录患者插管后、翻身侧卧位后、手术30 min时及术毕(平卧)时的Sp O2、Pet CO2和气道峰压(Ppeak)。结果 L组喉罩置入一次成功率100%,停药后清醒时间较T组缩短,差异有统计学意义(P0.01);喉罩拔出时间较T组短,差异无统计学意义(P0.05)。T组拔管后舌根后坠发生增多,差异有统计学意义(P0.05)。L组在T4时血压回升,而T组循环抑制持续至T5以后。T2、T6时,T组较L组血压升高、心率加快,差异有统计学意义(P0.01);T4时T组较L组血压降低,差异有统计学意义(P0.05)。L组和T组分别在喉罩置入(气管插管)后5 min内和5~10 min较多出现低血压,L组发生病例少于T组,差异有统计学意义(P0.01)。L组侧卧位后,气道密封压下降(P0.01),但仍然高于术中最高通气气道压(P0.01)。侧卧位即时(托管后)Pet CO2升高(P0.01);但手术结束时与平卧时比较,差异无统计学意义(P0.05)。结论老年患者髋部手术中使用喉罩通气全身麻醉,在体位变动时采用短时间脱管的方法可有效防止喉罩被拖拽移位、漏气,术中必须加强呼吸功能的监测;采用微泵注射结合静脉推注的慢诱导模式,减少集中给药引起的循环抑制。
[Abstract]:Objective to explore the management of respiratory and circulation during laryngeal mask ventilation under general anesthesia in elderly patients undergoing lateral supine hip surgery.Methods 52 elderly patients undergoing hip surgery were randomly assigned into group L (laryngeal mask general anesthesia) and group T (endotracheal intubation).Propofol and remifentanil were continuously injected intraoperatively, combined with sevoflurane inhalation anesthesia according to the intensity of surgical stimulation.The MAP and HRwere observed and recorded at 10 min after insertion, 1 min after intubation (laryngeal mask), 1 min after intubation (laryngeal mask), 5 min after intubation (laryngeal mask), 8 min after intubation (larynx mask), 8 min after intubation (larynx mask), 8 min after intubation (larynx mask).At 30 min and postoperatively (supine), SPO _ 2 Pet CO2 and peak airway pressure (Ppeaka) were observed after lateral supine position.Results the successful rate of laryngeal mask placement in group L was 100, the waking time after withdrawal was shorter than that in group T, the difference was statistically significant (P 0.01), the time of laryngeal mask pull-out was shorter than that in group T, and the difference was not statistically significant (P 0.05).There was a significant difference in blood pressure at T4 in P0.05U 路L group, while the blood pressure increased and heart rate increased in T group after T5. T2 + T6. The blood pressure in group T was significantly lower than that in group L at P0.01 and T4, and the blood pressure in group T was lower than that in group L.There were significant differences in the incidence of hypotension in group L and group T within 5 min after laryngeal mask placement (tracheal intubation) and 5 min after intubation. The incidence of hypotension in group L was less than that in group T, and the difference was statistically significant after lateral recumbent position in group P0.01.The airway seal pressure decreased (P 0.01), but it was still higher than the maximum airway pressure (P 0.01) during the operation.In the lateral position, Pet CO2 increased immediately, but there was no significant difference between the end of the operation and the supine position (P 0.05).Conclusion the laryngeal mask ventilation during hip operation is a general anesthesia in the elderly patients, and the short time extubation can effectively prevent the laryngeal mask from being towed and transposed. The monitoring of respiratory function must be strengthened during the operation.The slow induction mode of micropump injection combined with intravenous injection was used to reduce the circulatory inhibition caused by concentrated administration.
【作者单位】：江苏省昆山市中医医院;
【基金】：昆山市社会发展科技计划项目(编号:KS1440)
【分类号】：R614.2

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