喉罩联合支气管封堵器在胸科麻醉中的应用  

Application of laryngeal mask airway combined with bronchial blocker in patients undergoing thoracoscopic thymectomy

作　　者：刘志奇[1] 颜如玉 杨艳超[1] 马晓静[1] 宋铁鹰[1] LIU Zhi-qi;YAN Ru-yu;YANG Yan-chao;MA Xiao-jing;SONG Tie-ying(Department of Anesthesiology,the First Hospital of Shijiazhuang,Hebei Province,Shijiazhuang050011,China;Department of Anesthesiology,Traditional Chinese Medicine Hospital ofShijiazhuang,Hebei Province,Shijiazhuang 050051,China)

机构地区：[1]河北省石家庄市第一医院麻醉科,河北石家庄050011 [2]河北省石家庄市中医院麻醉科,河北石家庄050051

出　　处：《河北医科大学学报》2018年第11期1330-1333,共4页Journal of Hebei Medical University

基　　金：河北省医学适用技术跟踪项目(G2018112)

摘　　要：目的探讨喉罩联合支气管封堵器在胸科麻醉中应用的可行性。方法将择期行全身麻醉下胸科手术患者20例随机分为气管插管支气管封堵器组(T组)和喉罩支气管封堵器组(L组)各10例。所有患者麻醉诱导:静脉注射咪达唑仑0.05mg/kg,舒芬太尼0.4μg/kg,丙泊酚1.5mg/kg,待患者意识消失,静脉注射顺阿曲库铵0.2mg/kg,肌肉松弛完全后,T组插入7.5号加强型气管导管,L组插入3.0～5.0号喉罩,然后2组均在纤维支气管镜引导下插入支气管封堵器至术侧支气管,手术时支气管封堵器套囊充气,封闭术侧支气管,健侧肺单肺通气。记录2组插管前、插管即刻有创平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度、呼气末二氧化碳、乳酸水平和皮质醇浓度,比较2组支气管封堵器定位时间、术中肺萎陷情况、丙泊酚用药量、手术时间、出血量、拔管时间和术后气道黏膜损伤情况。结果T组插管即刻MAP、HR和皮质醇水平均明显高于插管前,差异有统计学意义(P<0.05),L组插管即刻除了HR较插管前略有升高外,其他指标无明显变化。插管即刻L组MAP、HR和皮质醇均低于T组,差异有统计学意义(P<0.05),2组支气管封堵器定位时间和肺萎陷程度差异无统计学意义(P>0.05),L组丙泊酚用量和拔管时间少于T组,差异有统计学意义(P<0.05)。结论喉罩联合支气管封堵器是一种较好的单肺通气方法,可安全有效地应用于胸科手术麻醉。Objective To study the feasibility of application of laryngeal mask with bronchial blocker for thoracic anesthesia.Methods Twenty patients were divided into 2 groups（ n =10 each）using a random number table： endotracheal tube bronchial blocker group（group T） and laryngeal mask plus bronchial blocker group（group L）. Midazolam 0.05 mg/kg, sufentanil 0.4 μg/kg, propofol 1.5 mg/kg and cisatracurium 0.2 mg/kg were injected intravenously for induction of anesthesia. An enhanced endotracheal tube with inner diameter 7.5 was inserted in group T, and the laryngeal mask airway was placed in group L .Then the bronchial blocker was inserted into the lateral bronchus under the guidance of fiberoptic bronchoscopy in 2 groups. During the operation the bronchial occluder cuff was inflated, and the surgical lateral bronchus was sealed, with one healthy lung ventilation. Mean arterial pressure（MAP）, heart rate（HR）, pulse oxygen saturation, end tidal carbon dioxide, lactic acid and cortisol concentration were recorded before intubation and intubation immediately. The positioning duration of bronchial occluder, pulmonary collapse, propofol dosage, operation time, bleeding volume, extubation time and postoperative airway mucosal injury were compared between the two groups.Results The MAP、HR and cortisol concentration were higher at intubation immediatelythan that before intubation in group T（ P 〈 0.05）.The data in group Lshowed no significant changesexcept that the HR increased. Compared with group T, the MAP、HR and cortisol concentration were lower in group L（ P 〈 0.05）. There were no significant differences in the positioning duration of bronchial occluder and pulmonary collapse between the two groups. Compared with group T, the propofol dosage were lower andthe extubation time was shorter in group L（ P 〈 0.05）.Conclusion Laryngeal mask with bronchial blocker may be considered an alternative one-lung ventilation technique, which can be used in thoracic anesthesia.

关 键 词：麻醉 胸外科手术 支气管封堵器 喉罩 

分 类 号：R614.1[医药卫生—麻醉学]