喉罩通气在甲状腺切除手术中对应激反应和通气的影响  

Effects of laryngeal mask airway ventilation on ventilation and stress during thyroidectomy

作　　者：杨晓明[1] 黄俊梅[1] 薛晓东[1] 任俊清[1] 宋志宏[1] 张亮[1] 

机构地区：[1]解放军空军总医院麻醉科,北京市100036

出　　处：《临床麻醉学杂志》2008年第3期220-222,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察甲状腺切除手术中运用喉罩通气对血流动力学、应激和通气功能的影响。方法择期行甲状腺切除术患者50例,年龄35～65岁,ASAⅠ或Ⅱ级,随机均分为气管导管组(T组)和喉罩组(L组)。记录患者入室安静5min时(T0)、插管前即刻(T1)、插管后即刻(T2)、插管后3min(T3)、拔管时(T4)和拔管后3min(T5)的MAP和HR,并于上述时间点采静脉血检测肾上腺素(E)、去甲肾上腺素(NE)水平。记录间歇通气10min(T6)、30min(T7)和60min(T8)时的分钟通气量(MV)、气道峰压(Ppeak)、潮气量(VT)和PETCO2。结果两组T6～T8时MV、VT、SpO2的差异无统计学意义。L组T8时的Ppeak和PETCO2高于T组(P<0·05),L组T2～T5时的MAP较T组降低,HR减慢(P<0·05)。T组T3～T5时的E、NE水平高于L组。T组T5时的E、NE水平高于T0(P<0·05),而L组的E、NE水平在T5与T0时比较差异无统计学意义。结论喉罩通气麻醉操作简便,通气可靠,对心血管系统刺激性小。Objective To investigate the effects of using laryngeal mask airway（LMA） for mechanical ventilation on stress and ventilation in patients undergoing thyroidectomy. Methods Fifty ASA class Ⅰ or Ⅱ patients aged 35-65 years undergoing thyroidectomy were enrolled in the study. The patients were randomized to receive either LMA ventilation （group L） or endotracheal intubation （group T） . Anesthesia was induced with midazolam 0.05 mg/kg , propofol 2 mg/ kg , fentanyl 3 μg/kg and norcuronium 0.10 mg/kg. HR and MAP were measured at 5 min after entering the operation-room （T0） ,before LMA insertion or intubation （T1） ,immediately after that （ T2 ） ,3 min after LMA insertion or intubation （T3） ,immediately after LMA withdrawal or extnbation （T4） and 3 min after LMA withdrawal or extubation（T5 ） . Blood specimens were taken at T0-T5 for determine of plasma concentration of epinephrine （E） and norepinephrine （NE） . Peak inspiratory airway pressure （Ppeak） ,minute volume （MV） ,tidal volume （VT） ,SpO2, and PETCO2 were recorded at 10 min of intermittent positive pressure ventilation （IPPV） （T6） ,30 min （T7） and 60 min （T8）. Results There was no significant difference in Ppeak, MV , VT, SpO2 at 10 min of IPPV ,30 min and 60 min between the two groups. Ppeak and PETCO2 in group L were higher than those in group T at 60 min of IPPV （P〈0.05）. The changes in MAP and HR in group L at T2 ,T3 ,T4and T5 were less than those in group T （P〈0. 05） . The concentrations of E and NE in group T at T3 ,T4and T5 were higher than those in group L and the concentrations of E and NE in T group at T5 were still higher than those at To （P〈0.05） . Conclusion LMA ventilation is efficacious for mechanical ventilation with simpler operation and less cardiovascular adverse response than endotracheal intubation.

关 键 词：喉罩 甲状腺切除术 应激反应 通气 

分 类 号：R614[医药卫生—麻醉学]