经皮左心耳封堵术麻醉方法的历史性队列研究  

A historical cohort study of anesthetic methods for percutaneous left atrial appendage closure

作　　者：姚海霞 吴镜湘[1] 吴东进[1] 黄成娅 陆惠捷 徐美英[1] Yao Haixia;Wu Jingxiang;Wu Dongjin;Huang Chengya;Lu Huijie;Xu Meiying(Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China)

机构地区：[1]上海市胸科医院,上海交通大学附属胸科医院麻醉科,200030

出　　处：《国际麻醉学与复苏杂志》2019年第8期754-758,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较不同的麻醉方式用于经皮左心耳封堵术的安全性、可行性,探讨左心耳封堵术的适宜麻醉方法。方法采用历史性队列研究的方法,将经皮左心耳封堵术99例患者按照麻醉方式分为3组:全身麻醉喉罩通气无肌松组(L组,19例),全身麻醉插管肌松拮抗组(S组,40例),全身麻醉插管无肌松拮抗组(G组,40例)。L组和S组用静脉靶控输注(target controlled infusion, TCI)丙泊酚和瑞芬太尼行麻醉诱导和维持;L组无肌松药,用喉罩;S组用罗库溴铵行气管插管,术毕舒更葡糖钠拮抗肌松;G组TCI丙泊酚,静脉注射舒芬太尼、顺苯磺酸阿曲库铵行气管插管,术毕未拮抗肌松。观察术毕停药至自主呼吸恢复时间、意识恢复时间、拔管时间、PACU停留时间、术中经食管超声探头放置成功率、术中喉罩移位或漏气发生率、喉罩改为气管插管率及苏醒后麻醉相关不良事件。结果L组、S组的自主呼吸恢复时间明显短于G组[(2.5±0.5)、(1.9±0.6)min比(22.2±7.1)min,P<0.05];意识恢复时间L组、S组[(3.4±0.6)min和(2.7±0.6)min]明显短于G组[(28.8±12.9)min](P<0.05);拔管时间L组和S组[(4.5±1.0)min和(3.6±1.0)min]明显短于G组[(34.6±16.0)min](P<0.05);PACU停留时间L组和S组[(28±4)min和(26±5)min],明显短于G组[(65±20)min](P<0.05);食管超声探头一次置入成功率L组为42.1%、S组和G组均>95%(P<0.05);术中喉罩移位率L组为36.8%;L组改为气管插管率为21.1%。S组、L组苏醒后一过性低氧血症、躁动、恶心呕吐及尿潴留等的发生率较G组低(P<0.05)。结论丙泊酚联合瑞芬太尼TCI、罗库溴铵全身麻醉插管、术毕舒更葡糖钠拮抗肌松的麻醉方法具有术中气道可控性好,术毕苏醒快、拔管早,一过性低氧血症、躁动发生率低等优势。Objective To explore the appropriate anesthetic method of percutaneous left atrial appendage closure by comparing the safety and feasibility of the different anesthetic methods. Methods Ninety nine patients with percutaneous left atrial appendage closure were divided into three groups according to anesthetic scheme by using a method of Historical Cohort Research: laryngeal mask general anesthesia without muscle relaxant (L group, n=19), endotracheal intubation general anesthesia with muscle relaxation antagonist (S group, n=40), and endotracheal intubation general anesthesia without muscle relaxation antagonist (G group, n=40). Target controlled infusion(TCI) of propofol and remifentanil for anesthesia induction and maintenance were used in L group and S group. The laryngeal mask was used in L group without muscle relaxants. Rocuronium was used for endotracheal intubation in S group, but the muscle relaxation was antagonized by sugammadex at the end of operation. Endotracheal intubation was performed after TCI propofol, intravenous sufentanil and cisatracurium in G group, but the muscle relaxation was not antagonized at the end of the operation. The outcome indexes were as follows: the time of spontaneous respiration, the time of consciousness recovery, the time of extubation, the time of staying at the postanesthesia care unit (PACU), the successful rate of esophageal ultrasonic probe placement, the incidence of displacement and air leakage of laryngeal mask, the incidence of replacement of a laryngeal mask with tracheal intubation during operation, and the adverse events after awakening. Results The recovery time of autonomic respiration in S group and L group were significantly shorter than that in G group[(2.5±0.5),(1.9±0.6) min vs (22.2±7.1) min, P<0.05]. The recovery time of consciousness was (3.4±0.6),(2.7±0.6) min in L group and S group respectively, both which were significantly shorter than that in G group[(28.8±12.9) min, P<0.05]. The time of extubation in L and S group was (4.5±1.0),(3.6±1.0)

关 键 词：左心耳封堵术 全身麻醉 舒更葡糖钠 

分 类 号：R614[医药卫生—麻醉学]