喉罩与气管插管用于甲状腺瘤全麻手术的比较研究

发布时间：2018-08-21 09:46

【摘要】：目的：探讨喉罩用于甲状腺瘤全麻手术的安全性及可行性,比较喉罩置入和气管插管下全身麻醉应用于甲状腺瘤切除术中血流动力学变化及应激反应,为临床麻醉提供参考。方法：延边大学附属医院选取甲状腺瘤病人40例,ASA分级Ⅰ～Ⅱ级。术前检查病人无循环及呼系系统疾患,无窦性心动过缓和高血压,均未发现肝,肾及内分泌等系统疾病,无张口困难和增加反流误吸危险因素,无通气困难等喉罩应用禁忌症。手术时间35-45分钟。患者随机分为喉罩全麻组(L组,20例)和喉镜引导下气管插管组(T组,20例)。全麻诱导咪唑安定0.05mg/kg,依托咪酯0.3mg/kg,注射用顺苯磺酸阿曲库铵0.2mg/kg,枸橼酸芬太尼0.1mg,静脉诱导3min后,插入气管导管或喉罩,记录两组患者心率(HR),收缩压(SBP),舒张压(DBP)和平均动脉压(MAP),并记录两组患者置入期,手术中,拔管期,术后24小时麻醉相关并发症及处理措施,统计两组患者苏醒时间,定向力恢复时间,拔管时间和麻醉费用情况。结果： ①喉罩置入时间平均值小于气管插管时间。气管插管组2例插管困难,经反复操作后成功。②喉罩组在T2、T4时的收缩压(SBP)、舒张压(DBP)、心率(HR)与To相比变化不大(P0.05)；气管插管组在T2、T4时的SBP, DBP和HR明显高于To(P0.05)；喉罩组与气管插管比较发现,喉罩组在T2-T5时的SBP、DBP和HR均明显低于气管插管组(P0.05)。③麻醉相关并发症。术后,气管插管组有3例咽痛,喉罩置入组无。④两组患者在苏醒时间,定向力恢复时间,拔管时间及麻醉费用方面差异无统计学意义(P0.05)。结论：全麻喉罩通气可以很好地应用于甲状腺瘤全麻手术患者,且优于气管内插管,易于维持血流动力学稳定,麻醉不良反应少,全麻后恢复平稳。
[Abstract]:Objective: to investigate the safety and feasibility of laryngeal mask in general anesthesia for thyroidoma, and to compare the hemodynamic changes and stress response between laryngeal mask placement and general anesthesia under tracheal intubation in thyroidectomy. To provide reference for clinical anesthesia. Methods: 40 patients with thyroid tumor were selected from affiliated Hospital of Yanbian University. There were no circulatory and respiratory system diseases, no sinus tachycardia and hypertension, no systemic diseases such as liver, kidney and endocrine, no difficulty in opening mouth and increasing risk factors of reflux missuction, no contraindication in laryngeal mask application. The operative time was 35-45 minutes. Patients were randomly divided into laryngeal mask general anesthesia group (group L, n = 20) and laryngoscopic tracheal intubation group (group T, n = 20). General anesthesia induced midazolam 0.05 mg / kg, etomidate 0.3 mg / kg, cisbenzenesulfonic acid 0.2 mg / kg, fentanyl citrate 0.1 mg / kg. After intravenous induction of 3min, tracheal catheter or laryngeal mask was inserted. Heart rate (HR), systolic blood pressure (HR), (SBP), diastolic pressure (DBP) and mean arterial pressure (MAP),) were recorded in both groups. The duration of implantation, operation, extubation, anaesthesia related complications and management were recorded. Orientation recovery time, extubation time and anaesthesia cost. Results: 1 the mean time of laryngeal mask placement was less than that of tracheal intubation. Two cases of tracheal intubation group were difficult to intubate, and the systolic pressure (SBP), diastolic pressure (DBP), heart rate (HR) of the laryngeal mask group at T _ 2 T _ 4 were not significantly different from that of to (P0.05), SBP, DBP and HR of tracheal intubation group at T _ 2 T _ 4 were significantly higher than to (P 0.05). Compared with tracheal intubation in laryngeal mask group, SBP DBP and HR in laryngeal mask group were significantly lower than those in tracheal intubation group (P0.05). There were no significant differences in recovery time, recovery time of directional force, extubation time and anaesthesia cost between the two groups in tracheal intubation group (3 cases), laryngeal mask group (4. 4) (P0.05). Conclusion: laryngeal mask ventilation under general anesthesia can be used well in patients with thyroid tumor undergoing general anesthesia, and is superior to endotracheal intubation. It is easy to maintain hemodynamic stability, has fewer adverse reactions, and recovers smoothly after general anesthesia.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1

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