Supreme喉罩与气管插管对老年高血压患者人工膝关节置换术应激反应的影响  

The effects between Supreme laryngeal mask airway and endotracheal intubation on stress reaction of elderly hypertensive patients treated with knee arthroplasty

作　　者：张海山[1] 王大龙[1] 左振芳[1] 葛维鹏[1] 王中伟[1] 郑观荣[1] 刘克[1] 王帅[1] 

机构地区：[1]山东省东营市胜利油田中心医院麻醉科,257034

出　　处：《临床麻醉学杂志》2014年第6期577-580,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨Supreme喉罩（SLMA）和气管插管对老年高血压患者人工膝关节置换术应激反应的影响。方法选择择期老年高血压人工膝关节置换术患者40例，ASAⅠ～Ⅲ级，采用随机数字表法，将患者均分为喉罩组（LMA组）和气管插管组（TT组）。采用相同的麻醉诱导和维持方法，患者入室后连续无创监测SpO2和ECG变化，连续监测SBP、DBP、HR，分别记录两组麻醉诱导前（T0，基础值）、插管（喉罩）后即刻（T1）、5min（T2）、15min（T3）时SBP、DBP、HR及血清皮质醇（Cor）、心钠素（ANP）含量、血浆肾上腺素（E）和去甲肾上腺素（NE）浓度。结果与T0时比较，T1～T3时LMA组患者SBP、DBP明显降低（P〈0．05或P〈0．01）；T1时TT组SBP、DBP明显升高，T2、T3时明显降低，T1时HR明显增快（P〈0．05或P〈0．01）。与LMA组比较，T1～T3时TT组SBP、DBP明显升高，T1、T2时HR明显增快（P〈0．05或P〈0．01）。与T0时比较，T1～T3时TT组E、NE浓度和Cor含量明显升高，且明显高于LMA组（P〈O．05或P〈0．01）；T1～T3时两组ANP含量明显升高，且TT组明显高于LMA组（P〈0．01）。结论与气管插管比较，SLMA可明显减轻老年高血压患者人工膝关节置换术全麻时的应激反应。Objective To investigate the effects of supreme laryngeal mask airway （SLMA） and endotracheal intubation on the elderly hypertensive patients treated with knee arthroplasty. Methods Forty cases of elderly hypertensive patients ASA Ⅰ -Ⅲ treated with knee arthroplasty in our hospital were selected and randomly divided into laryngeal mask airway group （group LMA） and endotracheal intubation （group TT）, 20 cases for each group. The same protocol for induction and maintenance of general anesthesia was used. After the patients entering, the changes of SpO2 and ECG were performed continuous noninvasive monitoring and SBP, DBP and HR were performed continuous invasive monitoring. SBP, DBP and HR of two groups were recorded at different time points： before anesthesia induction （To ,based value）, at intubation immediate （T1）, 5 mins after intubation （T2） and 15 mins after intubation （T3）. At the same time, the content of cortisol （Cot）, atrial natriuretic peptide （ANP） and the concentration of epinephrine （E） and norepinephrine （NE） were measured at the corresponding time points above. Results Compared with T0, SBP and DBP at T1-T3 in group LMA were decreased（P〈0.05 or P〈0. 01） ; SBP and DBP at T1 in group TT were increased while decreased at T2 ,T3, HR at T1 were increased（P〈0. 05 or P〈0. 01）. Compared with group LMA, SBP and DBP at T1-T3 and HR at T1 ,T2 in group TT were increased （P〈0. 05 or P〈0. 01）. Compared with To and group LMA, the content of E, NE and Cor at T1-T3 increased（P〈0. 05 or P〈 0.01）. The level of ANP in both groups at T1-T3 were higher than those at To ,and group TT were higher than group LMA（P〈0. 01）. Conclusion Compared to endotracheal intubation, SLAM can effectively reduce the stress reaction of elderly hypertensive patients treated with general anesthesia in knee arthroplasty.

关 键 词：SUPREME喉罩 气管插管 全身麻醉 老年 应激反应 人工膝关节置换术 

分 类 号：R614[医药卫生—麻醉学]