喉罩通气应用于老年患者腹部手术麻醉对术后肺部并发症的影响  

Effect of laryngeal mask airway on postoperative pulmonary complications in elderly patients undergoing abdominal surgery

作　　者：杨瑜汀 朱辉[2] 於章杰[2] 殷文渊[2] 郑丽[2] 杨立群[2] 

机构地区：[1]上海东方肝胆外科医院麻醉科,上海200438 [2]上海交通大学附属仁济医院麻醉科

出　　处：《上海医学》2015年第4期290-293,共4页Shanghai Medical Journal

摘　　要：目的队列分析行腹部手术的老年患者术中喉罩通气与气管插管对术后肺部并发症和患者病死率的影响。方法收集上海东方肝胆外科医院2010年1月—2013年7月间年龄>65岁、于全身麻醉下择期行腹部手术的患者的临床资料,将术中使用喉罩通气的患者列入喉罩组,使用气管插管通气的患者列入气管插管组,比较两组间患者的一般情况。收集并比较术后入ICU且需行机械通气患者的临床资料,以及术后入ICU且需行机械通气患者的肺部并发症情况。结果应用医院信息系统(HIS)共搜索到符合本研究纳入标准和排除标准的患者2 629例,其中喉罩组1 297例、气管插管组1 332例,两组间患者的性别构成、年龄、体重、术前血红蛋白(Hb)水平、美国麻醉医师协会(ASA)分级构成、术中出血量,以及术中输血和输液量的差异均无统计学意义(P值均>0.05)。术后需入ICU且需行机械通气的患者109例,喉罩组58例、气管插管组51例,两组间患者的性别构成、年龄、体重、平均住院天数、ICU住院天数、因肺部并发症和其他原因入ICU的构成比、ICU病死率,以及术后最高急性生理与慢性健康评分(APACHEⅡ评分)的差异均无统计学意义(P值均>0.05),喉罩组术后最高白细胞计数显著高于气管插管组(P<0.05)。喉罩组术后肺不张和肺栓塞发生率均显著低于气管插管组(P值均<0.05),两组间肺部感染、急性呼吸窘迫综合征(ARDS)和(或)急性肺损伤(ALI)、胸腔积液发生率的差异均无统计学意义(P值均>0.05)。结论与气管插管通气比较,喉罩通气并不能减少老年患者腹部手术后肺部并发症和死亡的发生。Objective To compare the incidence of postoperative pulmonary complications and mortality in elderly patients undergoing abdominal surgery through laryngeal mask airway （LMA） versus endotracheal intubation （ETI） by cohort analysis. Methods Clinical data of elderly patients aged over 65 years old and underwent elective abdominal surgery in Eastern Hepatobiliary Surgical Hospital between January 2010 and July 2013 were collected. Patients were divided into LMA group and ETI group according to their airway control moods. Clinical data and pulmonary complications in the patients who underwent ICU treatment and mechanical ventilation after surgery were compared between two groups. Results A total of 2 629 patients were enrolled in the study by hospital information system （HIS） collection. There were 1 297 patients in LMA group and 1 332 patients in ETI group. There were no significant differences in terms of demographic data （gender, age, body weight）, preoperative hemoglobin, American Society of Anesthesiologists （ASA） classification, intraoperative bleeding, transfusion of blood or fluids between groups （all P〈0.05）. After surgery, 109 patients （58 from LMA group and 51 from ETI group） were taken into ICU and mechanical ventilation was applied; there were no significant differences in gender, age, body weight, hospital stay, ICU stay, mortality or the highest acute physiology and chronic health evaluation （APACHE） Ⅱ scores between groups （all P〉0.05）; but the highest white blood count in LMA group was significantly more than that in ETI group （P〈0.05）. The incidences of postoperative atelectasis and pulmonary embolism in LMA group were significantly lower than those in ETI group （both P〈0.05）, but there were no significant differences in the incidences of pulmonary infection, acute respiratory distress syndrome （ARDS）, acute lung injury （ALl） or pleural effusion between groups （all P〉0.05）. Conclusion Laryngeal mask airway cannot reduce incidence an

关 键 词：喉罩 管插管 年患者 后肺部并发症 

分 类 号：R614[医药卫生—麻醉学]