Proseal喉罩全身麻醉复合硬脊膜外阻滞在腹腔镜直肠癌根治术中的应用  

General Anesthesia Via Proseal Laryngeal Mask Airway Combined with Epidural Block for Laparoscopic Radical Resection of Rectal Cancer

作　　者：周荣胜[1] 朱宇麟[1] 刘齐宁[1] 杨会[1] 何平[1] 马正敏[1] 毕阳[1] 

机构地区：[1]西安交通大学医学院第一附属医院麻醉科,西安710061

出　　处：《南昌大学学报（医学版）》2012年第10期57-60,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨Proseal喉罩全身麻醉复合硬脊膜外阻滞在腹腔镜直肠癌根治术中应用的安全性和可行性。方法将40例ASAⅠ-Ⅱ级、择期行腹腔镜直肠癌根治术的患者按随机数字表法分为2组:喉罩通气组(L组)和气管插管组(T组),每组20例。2组全身麻醉诱导前行T12-L1硬脊膜外穿刺。全身麻醉诱导后,L组置入喉罩,T组行气管内插管,2组均行控制呼吸。观察2组麻醉诱导前(T0)、插管(置入喉罩)即刻(T1)及插管(置入喉罩)后5(T2)、气腹后15(T3)、气腹后60(T4)、放气腹后5(T5)min和拔管(拔喉罩)即刻(T6),拔管(拔喉罩)后10(T7)min的血流动力学参数(SBP、DBP、HR、SpO2)、呼吸参数[气道峰压(Ppeak)、呼气末CO2分压(PETCO2)],以及术后苏醒时间、术后不良反应(血压升高、心率增快、恶心呕吐)、并发症(呛咳、咽痛、声嘶、反流误吸)、全身麻醉药(丙泊酚、瑞芬太尼、阿曲库铵)使用量的情况。结果 L组在T1、T6时HR、SBP、DBP值略高于T0,但差异无统计学意义(P>0.05)。T组在T1、T6时HR、SBP、DBP值均明显高于T0(P<0.05)。L组在T1、T6时HR、SBP、DBP值均明显低于T组(均P<0.05)。L组丙泊酚、瑞芬太尼、阿曲库铵使用量均明显少于T组(均P<0.05)。L组术后苏醒时间及术后血压升高、心率增快、恶心呕吐、呛咳、咽痛、声嘶发生率均明显低于T组(均P<0.05),L组反流误吸发生率与T组比较差异无统计学意义(P>0.05)。结论 Proseal喉罩全身麻醉复合硬脊膜外阻滞可安全、有效地用于腹腔镜下直肠癌根治术。Objective To explore the safety and feasibility of general anesthesia via Proseal la- ryngeal mask airway （PLMA） combined with epidural block for laparoscopic radical resection of rectal cancer. Methods Forty ASA I --II patients scheduled to undergo laparoscopic radical re- section of rectal cancer were randomly divided into two groups ：PLMA group（group L） and endo- tracheal tube group（group T）, with 20 patients in each group. Epidural puncture was performed at the TI2 --L1 level in all patients before anesthesia induction. After induction of general anesthe- sia,PLMA insertion and endotracheal intubation were carried out in group L and group T, respec- tively. All patients received controlled-ventilation. Systolic blood pressure （SBP）,diastolic blood pressure （DBP）, heart rate （HR）, oxygen saturation （SpO2）, peak airway pressure （Ppeak） and end-tidal CO2 partial pressure （PrTCO2） were measured before anesthesia induction（T0）,immedi- ately after insertion （T1）, 5 minutes after insertion（T2）, 15 minutes after pneumoperitoneum （T3） ,60 minutes after pneumoperitoneum （T4）,5 minutes after deflation （T5）, immediately after extubation （T6）, and 10 minutes after extubation（T2 ）. Furthermore, postoperative recovery time, postoperative adverse reactions （high blood pressure, heart rate increase, nausea and vomiting）, postoperative complications（choke cough, sore throat, hoarseness and countercurrent mistake in- halation） and amount of anesthetics（propofol,remifentanil and atracurium） were recorded. Results In group L,levels of SBP,DBP and HR at T1 and T6 were higher than those at To ,but the differ- ences were not significant（P〉0.05）. In group T,levels of SBP,DBP and HR at T1 and T6 were obviously higher than those at To （P〈0.05）. Compared with group T,levels of SBP,DBP and HR at T1 and T6, amount of anesthetics, postoperative recovery time and incidences of high blood pressure, heart rate increase, nausea, vomiting, choke cough,

关 键 词：PROSEAL喉罩 全身麻醉 硬脊膜外阻滞 腹腔镜直肠癌根治术 

分 类 号：R614.2[医药卫生—麻醉学] R614.42[医药卫生—外科学]