三通喉罩与气管导管用于支气管肺灌洗术时通气效果的比较  

Comparison of ventilatory effects between three-way laryngeal mask airway and tracheal catheter on patients during bronchoalveolar lavage

作　　者：杨天明 钟军 陆卫忠 赵东海 范新民 张春宝 韦海雷 

机构地区：[1]解放军第三〇三医院麻醉科,南宁530021 [2]解放军第三〇三医院呼吸科,南宁530021 [3]解放军第三〇三医院急诊科,南宁530021 [4]广西军区预备役师卫生科

出　　处：《中华急诊医学杂志》2011年第1期65-69,共5页Chinese Journal of Emergency Medicine

基　　金：广西壮族自治区卫生厅资助项目（GXZ2009396）

摘　　要：目的 对比研究三通喉罩（three-way laryngeal mask airway,TLMA）与气管导管（tracheal catheter,TC）通气用于全麻支气管肺灌洗术（bronchoalveolar lavage,BAL）对患者血流动力学、呼吸功能和应激激素水平的影响.方法 40例麻醉风险评估（ASA）Ⅰ-Ⅱ级在全麻下实施BAL的成人患者,按分层抽样原则分为TLMA组（T组,n=20）和TC组（C组,n=20）,记录麻醉诱导前（To）,插入TLMA/TC前（T1）,插入TLMA/TC即刻（T2）,插入TLMA/TC通气3 min（T3）,5 min（T4）,10 min（T5）,实施BAL 10min（T6）,20 min（T7）,30 min（T8）,拔除TLMA/TC即刻（T9）和拔除TLMA/TC后3 min（T10）的SpO2,SBP,DBP和HR.连续监测呼吸功能指标,记录T2,T4,T6,T7,T8,T10的潮气量（VT）,气道峰压（Ppeak）及呼气末二氧化碳分压（PETCO2）;应用高效液相色谱分析法测定T0,T2,T3,T4,T6,T9,T10的静脉血浆肾上腺素（AE）,去甲肾上腺素（NE）和多巴胺（DA）水平.采用SPSS 10.0统计软件,血液动力学及应激激素指标行重复测量数据的方差分析,以P＜0.05为差异具有统计学意义.结果 C组T2,T3,T9时SBP,DBP,HR显著高于T组（P＜0.05）;C组Ppeak在T6,T7,T8显著高于T组（P＜0.05）;C组AE,NE在T2,T3和T9均显著高于T组（P＜0.05）.结论 在全麻BAL中,TLMA通气优于TC通气,其血流动力学更稳定,应激反应更轻微.Objective To compare the ventilatory effects between three-way laryngeal mask airway （TLMA）and tracheal catheter （TC） on hemodynamics, respiratory function and stress responses on patients during bronchoalveolar lavage （BAL）. Method Forty patients scheduled for BAL under general anesthesia were divided （stratified sampling） into either TLMA group （group T,n = 20） or TC group （group C, n = 20） according to the stratified sampling principle. SpO2, SBP, DBP and HR were measured in 5 min after entering the operating theater （To）, just before inserting TLMA or TC（T1）, immediately after inserting TLMA or TC（T2） ,3 min（T3）, 5 min（T4）, 10 min（T5）after mechanical ventilation, 10 min（T6）,20 min（T7）, 30 min（T8）during the course of BAL,immediately after extubating TLMA or TC （T9）and 3 min after extubating TLMA or TC （T10）. The tidal volume （VT）, peak inspiratory airway pressure （Ppeak） and end expiratory CO2 pressure（PETCO2）were recorded at T2,T4,T6,T7, T8, T10. The venous blood samples were taken at T0, T2, T3, T4, T6, T9, T10 for the measurements of epinephrine（AE）, norepinephrine（NE）and dopamine （DA） levels with high performance liquid chromatography.Data were dealt with SPSS version 10.0 statistic software. The variables of hemodynamics and stress responses were analyzed with ANOVA of repeating test data. P 〈 0.05 means the difference in statistical significance. Results In group C, SBP, DBP and HR were significantly higher than those in group T at T2 ,T3 ,T9 （P 〈 0.05）. In group C, the levels of Ppeak were significantly higher than those in group T at T6 ,T7 ,T8 （P 〈 0.05）, and the concentrations of AE, NE and DA were also significantly higher in group C than those in group T at T2, T3 and T9 （P 〈0.05）. Conclusions Ventilation with TLMA in patients during BAL is better than TC in respects of keeping stable ventilation, stable hemodynamics and producing less stress responses.

关 键 词：肺灌洗 通气效果 气管导管 三通喉罩 血流动力学 呼吸功能 应激反应 

分 类 号：R614[医药卫生—麻醉学]