喉罩用于静脉复合麻醉下颅骨修补术的气道管理体会  

Clinical experience of applying laryngeal mask to cranioplasty

作　　者：余骏马[1] 朱海娟[1] 方向东[1] 徐瑞好[1] 

机构地区：[1]合肥市第一人民医院麻醉科,安徽合肥230061

出　　处：《皖南医学院学报》2006年第4期295-297,共3页Journal of Wannan Medical College

摘　　要：目的：观察喉罩应用于瑞芬太尼复合丙泊酚静脉麻醉下行颅骨修补术的临床效果及安全性。方法：选择ASAⅠ～Ⅱ级，行择期颅骨修补术患者20例。麻醉诱导为缓慢静注丙泊酚2mg／kg，瑞芬太尼1μg／kg。诱导后3～5min后待患者意识消失、无明显对抗时置入喉罩，保留自主呼吸。麻醉维持为丙泊酚5mg／（kg·h），瑞芬太尼0．1μg／（kg·h）。手术开始时，由手术者采用0．5％利多卡因在手术区域行局部浸润麻醉。严密观察并记录患者心率（HR）、血压（BP）、脉搏血氧饱和度（SpO2）、呼吸频率（RR）的变化及术毕患者苏醒时间。结果：20例患者麻醉效果均满意。麻醉期间各时间点HR、BP、SpO2及RR值无显著性差异（P〉0．05）。术毕至患者OAA／S评分≥4分的时间为（7．53±2．56）min。麻醉期间4例患者出现一过性呼吸抑制（SpO2〈93％）．无低血压，无恶心、呕吐，无心动过缓。1例女性患者术毕苏醒后烦躁。结论：瑞芬太尼复合丙泊酚加局麻配合使用喉罩应用于颅骨修补术，是一种安全、可靠的麻醉方法。Objective：To observe clinically the efficacy and salty of applying laryngeal mask airway to cranioplasty by intravenous anesthesia with remifentanil-propofol. Methods： 20 patients with ASA Ⅰ-Ⅱ undergone selective cranioplasty by anesthesia induction with intravenous infusion of 2 mg/kg propofol and 1 μg/kg remifentanil were investlgated. Those cases were inserted laryngeal mask airway （LMA） after in duction of 3 to 5 minutes with deprived to maintain them selves spontaneously breathing during operation. Combination of intravenous infusion of 5 mg/（ kg· h） propofol and 0.1 μg/（kg· h） remifentanil was used for maintenance of anesthesia. Local infiltration anesthesia with 0.5% lidocaine was administered in operative site instantly before operation, and those data of change of HR,BP,SpO2 ,RR and consciousness recovery after operation were recorded. Results ： All the 20 cases had got a satisfactory efficacy of anesthesia. Recordings of HR , BP , SpO2 and RR showed no statistical difference（P 〉 0.05） during the operation. The score of OAA/S≥4 was（7.53 ± 2.56） min. No complications as low blood pressure, nausea, vomiting or bradycardia were observed except for transient respiratory depression occurrence in 4 cases and restlessness in 1 case after operation. Conclusion ： Combined application of laryngeal mask airway under intravenous infusion of remifentanil and propofol anesthesia is safe and reliable in cranioplasty.

关 键 词：喉罩 瑞芬太尼 丙泊酚 颅骨修补术 

分 类 号：R614.24[医药卫生—麻醉学]