i-gel喉罩联合气管导管全身麻醉在老年患者ii-俯卧位胸腰椎手术中的应用

发布时间：2018-05-29 06:22

本文选题：i-gel喉罩 + 气管插管　；参考：《山东大学》2016年硕士论文

【摘要】：目的：探讨i-gel联合气管导管全身麻醉在老年患者俯卧位胸腰椎手术中应用的临床效果及安全性。方法：选取60例年龄≥65岁,骨科行俯卧位胸腰椎择期手术的患者,随机编入i-gel联合气管导管组(IT组)和单纯气管导管组(T组)。IT组和T组均常规准备,留置外周静脉通路后推入手术室,并实时监测心率、血压及脉搏氧饱和度。两组患者均先后静脉推注咪达唑仑0.05 mg/kg.依托咪酯0.2 mg/kg.舒芬太尼0.5 ug/kg、罗库溴铵1 mg/kg,行快速静脉诱导,辅助呼吸5 min后,IT组置入i-gel喉罩,置入成功后以胶带固定,连接麻醉机机械通气,选择通气模式为容量控制,设置潮气量8 ml/kg,通气频率12次/min,吸呼比1：1.5,氧流量2 L/min。机械通气5 min后,经i-gel喉罩置入气管导管,充起气囊,两肺听诊呼吸音对称,以胶带将气管导管与i-gel喉罩固定为一体,气管导管一端连接麻醉机,以原通气模式通气。T组采用喉镜暴露声门,置入加强型气管导管,连接麻醉机机械通气,通气模式同IT组。麻醉维持：持续静脉输注丙泊酚4.5 mg/kg/h.瑞芬太尼10 ug/kg/h,吸入七氟烷0.8～1.0 MAC,术中调节麻醉维持药物的输注速度,维持BIS值在40-60之间。间断静脉推注顺式阿曲库铵0.1 mg/kg直至手术结束前1 h,以维持患者肌松, 维持患者生命体征平稳。两组患者均在俯卧位下行手术,术毕前,待患者恢复仰卧位后,停止泵注丙泊酚及瑞芬太尼,IT组在麻醉状态下吸痰拔出气管导管,以i-gel喉罩维持通气；T组继续以气管导管维持通气。待患者意识清醒、自主呼吸恢复、肌力恢复、脱氧5 minSpO2能维持在95%以上时拔出i-gel喉罩／气管导管。观察并且记录两组患者的年龄、性别、体重、身高、ASA分级、手术时间、麻醉及苏醒时间；分别在麻醉诱导前(TO)、诱导结束置入气管导管即刻(T1)手术结束拔出i-gel喉罩或气管导管即刻(T2)、拔出i-gel喉罩或气管导管后5min(T3)时记录两组患者的MAP、HR、SpO2;抽取静脉血测定两组患者T0-T3各时点的血糖及血浆皮质醇浓度水平；记录平卧位两组患者置入气管导管后5min(T4)、俯卧位手术开始后30min(T5)及术毕即刻俯卧位时(T6)的Ppeak. PETCO2。结果：两组患者一般情况、麻醉时间、手术及拔管时间差异均无统计学意义(P0.05)。与TO相比,T组患者T1、T2、T3各时点MAP、HR均明显升高(P0.05)；IT组患者则无明显变化(P0.05)。与T组相比,IT组患者T1、T2、T3各时点MAP、HR明显降低(P0.05)。与TO相比,两组患者T1、T2、T3各时点血糖及血浆皮质醇水平均明显升高(P0.05)；与T组相比,IT组患者T1、T2、T3各时点血糖及血浆皮质醇水平均显著降低(P0.05)。与T组相比,IT组患者T4、T5、T6各时点Ppeak明显升高(P0.01),但通过适当调快呼吸频率,所有患者的Ppeak都不高于25cmH2O此外,通过适当调快呼吸频率,减少潮气量,两组患者的PETCO2均控制在35～45mmHg之间,结果无明显差异(P〉0.05)。结论：老年患者俯卧位胸腰椎手术使用i-gel喉罩联合气管导管全身麻醉,气道稳定性和通气安全性和单纯气管插管相似,但患者围麻醉期的血流动力学更加稳定,应激反应程度也大大降低,术后麻醉苏醒质量高,安全性及可控性好。
[Abstract]:Objective: To investigate the clinical effect and safety of I-gel combined with tracheal tube general anesthesia in the prone position of thoracic and lumbar vertebrae in elderly patients. Methods: 60 patients aged 65 years old and 65 years old, the patients in the prone position of thoracic and lumbar elective surgery were randomly assigned to I-gel combined tracheal catheter group (group IT) and simple tracheal catheter group (group T).IT and T group. The two groups of patients were given intravenous injection of midazolam 0.05 mg/kg. etomidate 0.2 mg/kg. sufentanil 0.5 ug/kg and rocuronium 1 mg/kg, and the IT group was placed in the I-gel laryngeal mask after 5 min assisted respiration. After success, it was fixed with adhesive tape, mechanical ventilation with anesthesia machine, ventilation mode for capacity control, setting moisture volume 8 ml/kg, ventilation frequency 12 times /min, suction ratio 1:1.5, oxygen flow 2 L/min. mechanical ventilation 5 min, I-gel laryngeal mask airway catheter, filling air bag, two lung auscultation breathing sound symmetry, duct duct and I-gel larynx with adhesive tape One end of the mask was connected with the anesthesia machine, and the.T group was ventilated by the original ventilation mode to expose the glottis with laryngoscope, put into the reinforced tracheal tube, connect the mechanical ventilation with the anesthesia machine, the ventilation mode and the IT group. The anesthesia was maintained: continuous intravenous infusion of propofol 4.5 mg/kg/h. renfentanyl 10 ug/kg/h, inhaled seven fluorane 0.8 ~ 1 MAC, intraoperative regulation The anesthesia maintained the infusion speed of the drug, maintaining the value of BIS between 40-60. Intermittent intravenous infusion of CIS atracurium 0.1 mg/kg until 1 h before the end of the operation, to maintain the patient's muscle relaxation and maintain the patient's vital signs. The two groups were operated in the prone position, and the patient was restored to the supine position before the patient was restored to the supine position and stopped pumping propofol and remifentin In group IT, the tracheal tube was drawn out in the anesthetized state, and the ventilation was maintained with the I-gel laryngeal mask, and the T Group continued to maintain ventilation with the tracheal catheter. The patients were awake, self breathing recovery, the muscle strength recovery, and the deoxygenation 5 minSpO2 could be pulled out of the I-gel laryngeal mask / tracheal catheter. The age, sex, weight of the two groups of patients were observed and recorded. Height, ASA classification, operation time, anesthesia and awakening time, respectively, before induction of anesthesia (TO), the end of the induction endotracheal catheter at the end of the induction (T1) to pull out the I-gel laryngeal mask or the tracheal catheter immediately (T2), the I-gel laryngeal mask or the tracheal catheter after 5min (T3) recorded the two groups of MAP, HR, SpO2; extraction of venous blood of two groups of patients T0-T3 each Blood glucose and plasma cortisol concentration at the time point; recorded the 5min (T4) of the two groups of patients in the supine position, 30min (T5) after the prone position and the Ppeak. PETCO2. in the immediate prone position (T6): the general situation, the time of anesthesia, the difference of hand and extubation time were not statistically significant (P0.05) in the two groups (P0.05). In group T, T1, T2, and T3 were significantly higher in MAP and HR at each time point (P0.05), and there was no significant change in IT group (P0.05). Compared with the T group, IT group was significantly lower. Time point blood glucose and plasma cortisol level were significantly decreased (P0.05). Compared with group T, the Ppeak of T4, T5, T6 at each time point in group IT was significantly increased (P0.01), but the Ppeak of all patients was not higher than 25cmH2O by appropriate rapid respiration rate, and the volume of moisture was reduced by the appropriate rate of respiratory frequency, and the PETCO2 of the two groups was controlled in 35 ~ 45mmHg. There was no significant difference between the results (P 0.05). Conclusion: the elderly patients with the prone position of the thoracic and lumbar spine were treated with the I-gel laryngeal mask combined with tracheal catheter general anesthesia, the airway stability and ventilation safety were similar to the simple tracheal intubation, but the hemodynamics of the patients during the perioperative period were more stable, the degree of stress reaction was greatly reduced, and the postoperative anesthesia revived. High quality, good safety and good controllability.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R614.2

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