一次性双腔无囊喉罩I-gel在烧伤手术麻醉中的应用  

The application of one-time double lumen without bladder mask I-gel in burn operation anesthesia patients

作　　者：王霆[1] 吴亚谋[1] 杨卫国[1] 王小楠[1] 黄晓晨[1] WANG Ting;WU Yamou;YANG Weiguo;WANG Xiaonan;HUANG Xiaochen(Northern district of Suzhou municipal hospital,anesthesiology department,Suzhou,Jiangsu 215000,China)

机构地区：[1]苏州市立医院北区麻醉科,江苏苏州215000

出　　处：《安徽医药》2018年第7期1360-1363,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的一次性双腔无囊喉罩I-gel与气管插管在成人烧伤患者麻醉中的应用观察及优缺点比较。方法选择50例择期手术成人烧伤患者随机数字表法分成两组,喉罩组采用I-gel喉罩行麻醉(n=25)、插管组采用气管插管行麻醉(n=25),麻醉方法均选用全凭静脉麻醉,用药剂量及种类差异无统计学意义。记录麻醉诱导后(T_1),插入I-gel喉罩或气管导管后(T_2),术毕停止输注麻醉药物后5min(T_3),拔出I-gel喉罩或气管导管后(T_4),患者各时段平均动脉压(MAP),心率(HR),脉搏血氧饱和度(Sp O2),及T_2、T_3、T_4时间点呼气末二氧化碳分压(PET_CO2),分别计算两组中每位患者使用丙泊酚、瑞芬太尼、顺阿曲库铵的总量,并记录苏醒时间和拔管后的并发症。结果插管组T_2、T_4时段MAP、HR分别为(89.4±8.3)mm Hg、(96.0±7.7)mm Hg、(99.4±4.9)次/分钟、(100.6±5.6)次/分钟明显高于喉罩组(P<0.05),与T_1,T_3时段比较,插管组MAP、HR数值则明显升高(P<0.05),喉置组则无明显变化(P>0.05)。两组不良反应包括苏醒躁动、呛咳屏气、术后咽痛喉罩组少于插管组(喉罩组比插管组依次为4.0%比28.0%、0.0%比20.0%、4.0%比28%,均P<0.05)。而喉罩组丙泊酚与顺阿曲库铵的用量也明显少于插管组(P<0.05),喉罩组苏醒时间(4.1±2.2)min明显快于插管组(8.1±3.0)min(P<0.05)。结论与气管插管全麻相比,I-gel喉罩在成人烧伤患者的应用有血流动力学更稳定,麻醉平稳,患者舒适度高的优势。Objective To observe the application of i-gel throat mask and tracheal intubation in the anesthesia of adult burn patients and their advantages and disadvantages. Methods 50 patients undergoing elective surgery in adult burn patients were randomly divided into two groups,namely I-gel laryngeal mask group（ group L,n = 25）,endotracheal intubation group（ T group,n = 25）,anesthesia method selects all by intravenous anesthesia,dosage and types with no difference. After anesthesia induction（ T1）,insert the Igel after laryngeal mask or the endotracheal tube（ T2）,5 minutes after surgery to stop infusion anesthesia（ T3）,pull out the I-gel after laryngeal mask or the endotracheal tube（ T4） in each period in patients with mean arterial pressure（ MAP）,heart rate（ HR）,pulse oxygen saturation（ SpO2）） and T2,T3,T4 time point out at the end of the CO2 partial pressure（ PETCO2） were recorded. The total amount of propofol,rimifentanil and cis-atracurium in each of the two groups were calculated,and the awakening time and complications after extubation were recorded. Results During the T2,T4,MAP and HR of the intubaton group were respectively（ 89. 4 ±8. 3） 、（ 96. 0 ± 7. 7） mm Hg,（ 99. 4 ± 4. 9） 、（ 100. 6 ± 5. 6） times per minute which were significantly higher than that of group L（ P〈0. 05）. Compared with T1 and T3,MAP and HR of group T were significantly higher（ P〈0. 05）. The adverse reactions included resuscitation,choking,postoperative pharyngeal pain,which L group compared with T group（ 4. 0% vs 28. 0% 、0. 0% vs 20. 0% 、4. 0% vs 28. 0%） were significantly less（ P〈0. 05）. The dosage of L group propofol and cis-atracurium was significantly lower than that of T group（ P〈0. 05）. The wake time of group L was significantly faster than T group（ P〈0. 05）. Conclusion compared with endotracheal intubation,the application of i-gel throat mask in adult burn patients has more stable hemodynamics,stable anesthesia and high comfort.

关 键 词：麻醉 全身 喉面罩 插管法 气管内 烧伤 二异丙酚 阿曲库铵 

分 类 号：R614[医药卫生—麻醉学]