喉罩联合支气管封堵器在重症肌无力患者胸腔镜手术中的应用  

The application of laryngeal mask airway combined with bronchial blocker in myasthenia gravis patients undergoing thoracoscopic thymectomy

作　　者：宋铁鹰[1] 杨艳超[1] 王虹[1] 张玉强[1] 刘志奇[1] SONG Tie-ying;YANG Yan-chao;WANG Hong;ZHANG Yu-qiang;LIU Zhi-qi(Department of Anesthesiology,the First Hospital of Shijiazhuang,Hebei Province,Shijiazhuang 050011,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

出　　处：《河北医科大学学报》2018年第12期1451-1454,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：目的评价喉罩联合支气管封堵器在重症肌无力患者行胸腔镜下胸腺切除手术中的应用效果。方法将择期胸腔镜下胸腺切除手术的重症肌无力Ⅰ型或ⅡA型患者16例采用随机数字表法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8例。麻醉诱导:依次静脉注射咪达唑仑0.04mg/kg,舒芬太尼0.3～0.4μg/kg,异丙酚1～2mg/kg,顺阿曲库铵0.1mg/kg,T组插入气管插管支气管封堵器,L组先置入喉罩再放置支气管封堵器,并行纤维支气管镜定位。记录麻醉诱导前和气管插管时的血压和心率,计算变化差值(△BP、△HR),于单肺通气10min时采集动脉血样1mL进行血气分析,记录氧分压、二氧化碳分压、气道峰值压力,并计算肺动态顺应性,记录术中肺萎陷情况,术后6h随访,记录患者有无咽喉痛、恶心呕吐等并发症。结果 L组气管插管时△BP、△HR明显低于T组,差异有统计学意义(P<0.05);2组单肺通气时氧分压、二氧化碳分压、气道峰值压力、肺动态顺应性、肺萎陷评分、咽喉痛和恶心呕吐发生率差异均无统计学意义(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,可以在胸腔镜下重症肌无力手术中应用。Objective To evaluate the feasibility of application of laryngeal mask combined with bronchial blocker for thoracoscopic thymectomy in myasthenia gravis patients.MethodsSixteen patients with myasthenia gravis type Ⅰ or type Ⅱ A,scheduled for thoracoscopic thymectomy,were divided into endotracheal tube bronchial blocker group（group T）and laryngeal mask plus bronchial blocker group（group L）（n =8 each）using a random number table.Midazolam 0.04 mg/kg,sufentanil 0.3-0.4μg/kg,propofol 1-2 mg/kg and cisatracurium 0.1 mg/kg were injected intravenously for induction of anesthesia.endotracheal tube with a bronchial blocker was intubated in group T,Patients in the group L was placed laryngeal mask followed by a bronchial blocker,and the accuracy was assessed by using a flexible fiberoptic bronchoscopy.Blood pressure and heart rate were recorded before anesthesia induction and endotracheal intubation,and the different values（△BP and△HR）were calculated.The arterial blood samples1 ml were collected for blood gas analysis at 10 min after one lung ventilation.The partial pressure of oxygen（PaO2）,partial pressure of carbon dioxide（PaCO2）,and peak airway pressure（Ppeak）were recorded,and the dynamic compliance（Cdyn）was calculated.Intraoperative pulmonary collapse was observed.The patients were followed up 6 hours after operation to record whether there were complications such as sore throat,nausea and vomiting.Results Compared with groupT,the △BP and △HR were lower in group L（P〈0.05）.There were no significant differences between the two groups in PaO2,PaCO2,Ppeak,Cdyn,the quality of lung collapse,and the incidences of throat pain,nausea and vomiting（P〉0.05）.Conclusion laryngeal mask plus bronchial blocker may be considered an alternative one-lung ventilation technique,which can be used in thoracoscopic myasthenia gravis surgery.

关 键 词：重症肌无力 胸腔镜检查 喉罩 支气管封堵器 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R614.21[医药卫生—临床医学]