三通喉罩通气在纤维支气管镜检查术中对血流动力学和应激激素水平的影响  

Effects of three-way laryngeal mask airway ventilation on hemodynamics and stress responses during bronchoscopy

作　　者：邵丽[1] 杨鲜妮[2] 陆卫忠[3] 全超坤[4] 

机构地区：[1]解放军第三〇三医院内分泌科,广西南宁530021 [2]解放军第三〇三医院麻醉科,广西南宁530021 [3]解放军第三〇三医院呼吸科,广西南宁530021 [4]解放军第三〇三医院耳鼻咽喉科,广西南宁530021

出　　处：《临床荟萃》2014年第11期1224-1227,共4页Clinical Focus

摘　　要：目的：评价三通喉罩（three-way laryngeal mask airway,TLMA）通气用于纤维支气管镜检查术对患者血流动力学和应激激素水平的影响。方法麻醉风险评估（ASA）Ⅰ-Ⅱ级的患者60例,按分层抽样原则分为3组（n=20）：局部麻醉组（A组）,全身麻醉内镜面罩通气组（B组）及全身麻醉TLMA通气组（C组）。3组均采用超声雾化器吸入2%利多卡因15分钟进行表面麻醉；B组和C组静脉注射芬太尼1.0μg/kg、异丙酚1.5mg/kg,微泵连续输注异丙酚6.0mg·-1·h-1维持麻醉。B组通过内镜面罩供氧,C组插入TLMA控制呼吸。记录患者基础值（T0）、纤维支气管镜入声门前（T1）、入声门（T2）、入声门后3分钟（T3）、活组织检查（T4）、出声门（T5）时的心率（HR）、收缩压（SBP）、舒张压（DBP）和血氧饱和度（SaO2）变化；应用高效液相色谱分析法测定静脉血浆肾上腺素（E）、去甲肾上腺素（NE）和多巴胺（DA）水平。结果A组SBP、DBP和HR在T2、T3、T4、T5时均显著高于T0（P〈0.01）,也显著高于B组和C组（P〈0.01）。A组的E、NE和DA在T2、T3、T4、T5时显著高于B组和C组（P〈0.01）。结论纤维支气管镜检查术时,TLMA通气效果满意,患者血流动力学和应激激素水平更稳定。Objective To evaluate the effects of three-way laryngeal mask airway （TLMA ） mechanical ventilation on the hemodynamics and stress responses of patients during bronchoscopy.Methods Sixty patients with ASA class Ⅰ or Ⅱ and undergoing bronchoscopy were divided into three groups according to the stratified sampling principle （n =20 each）：topical anesthesia （group A）,intravenous anesthesia with endoscopic mask ventilation （group B）and intravenous anesthesia with TLMA ventilation （group C）.Topical anesthesia with 20 ml 2% lidocaine was applied for the patients in all the three groups.Patients in group B and group C also received intravenous injection with fentanyl （1.0 μg/kg ） and propofol （1.5 mg/kg ）,followed by sustaining anesthesia with micropump actuated continuous injection of propofol （6.0 mg/kg · h）.Heart rate （HR）,systolic blood pressure （SBP）,diastolic blood pressure（DBP）and arterial oxygen saturation（SaO 2 ）were continuously monitored during anesthesia and measured at 5 min after entering the surgery room（T0 ）,just before the bronchoscope entering the glottis（T1 ）,immediately after the bronchoscope entering the glottis（T2 ）,3 min after the bronchoscope entering the glottis（T3 ）,the time of biopsy（T4 ） and immediately after the bronchoscope extubated from the glottis（T5 ）.Blood samples collected at T0 ,T1 ,T2 ,T3 ,T4 and T5 were used for the determination of plasma epinephrine（E）,norepinephrine（NE）and dopamine（DA）using high performance liquid chromatography.Results SBP,DBP and HR in group A increased significantly at T2 ,T3 ,T4 and T5 as compared with those at baseline （P 〈0.01）.They were also significantly higher than those in groups B and C at the corresponding time points （P 〈0.01）.The levels of E,NE and DA in group A were significantly higher than those in groups B and C at T2 ,T3 ,T4 and T5 （P 〈 0.01 ）.Conclusion TLMA is more effective in maintaining stable ventilation and stable hemodynamics an

关 键 词：肺疾病 支气管镜检查 血流动力学 三通喉罩 

分 类 号：R563[医药卫生—呼吸系统]