双腔喉罩在老年房颤病人射频消融术中的应用效果  

Application effect of ProSeal laryngeal mask airway for catheter radiofrequency ablation in elderly patients with atrial fibrillation

作　　者：孙兆楚 丁正年 王娟[1] SUN Zhao-chu;DING Zheng-nian;WANG Juan(Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,江苏省南京市210029

出　　处：《实用老年医学》2020年第9期923-926,共4页Practical Geriatrics

摘　　要：目的比较双腔喉罩(ProSeal laryngeal mask airway,PLMA)和气管插管应用于老年房颤病人全麻射频消融术中的安全性与优越性。方法选择我院择期行全麻房颤射频消融术的老年病人80例,采用随机数字表法分为双腔喉罩组(L组)、气管插管组(C组),每组40例。2组病人均常规麻醉诱导,待药物完全起效后,L组置入PLMA,C组行气管插管。记录2组麻醉诱导前(T0)、插入喉罩或气管导管前(T1)、插入喉罩或气管导管即刻(T2)以及拔除喉罩或气管导管前后(T3、T4)的平均动脉压(MAP)、心率(HR);记录2组手术时间、透视时间、消融时间、麻醉药用量以及术者满意度;观察病人拔管时间、出室时间,以及围拔管期相应并发症的发生率。结果2组病人一般情况比较,差异均无统计学意义;C组T2、T4时刻MAP与HR均较T1、T3时刻高,且明显高于L组(P<0.05);与C组相比,L组手术时间、消融时间、拔管时间及出室时间均更短(P<0.05);L组麻醉药用量少,术者满意度更高(P<0.05),且围拔管期不良反应的发生率也明显低于C组(P<0.05)。结论PLMA可以安全有效地应用于老年房颤病人射频消融术中麻醉。与气管插管相比,PLMA不仅能够维持血流动力学稳定,而且能够提供更优的手术条件及气道保护,值得在临床上推广使用。Objective To compare the safety and superiority between the ProSeal laryngeal mask airway(PLMA)and endotracheal intubation in the elderly patients receiving radiofrequency catheter ablation(RFCA)of atrial fibrillation.Methods A total of 80 elderly patients with persistent atrial fibrillation who received RFCA under general anesthesia were enrolled in this study.The patients were randomly divided into PLMA group(group L)and tracheal intubation group(group C),with 40 cases in each group.The patients in two groups were anesthesia induced routinely,PLMA or endotracheal intubation were placed in group L and group C respectively.The levels of mean arterial pressure(MAP)and heart rate(HR)were recorded at the time of initial stage(T0),before tracheal intubation(T1),immediately after tracheal intubation(T2),before and after removing the tracheal extubation(T3 and T4).The operation time,fluoroscopy time,ablation time,anesthetic dosage and surgeon satisfaction were recorded.The time of extubation,time out of the operation room,and the incidence of related complications in the peri-extubation period were recorded and compared between the two groups.Results There was no significant difference in the general situation between the two groups.At T2 and T4,the levels of MAP and HR in group C were higher than those at T1 and T3,and significantly higher than those in group L(P<0.05).Compared with group C,the operation time,ablation time,extubation time,and time out of the operation room were shorter in group L(P<0.05).The patients in group L had less anesthetic dosage and higher surgeon satisfaction(P<0.05),and the incidence rate of adverse reactions during perioperative extubation was also significantly lower than that in group C(P<0.05).Conclusions PLMA can be used for RFCA anesthesia safely and effectively in the elderly patients with atrial fibrillation.Compared with endotracheal intubation,PLMA can not only maintain hemodynamic stability but also provide better surgical conditions and airway protection.

关 键 词：双腔喉罩 房颤 射频消融术 老年人 

分 类 号：R614[医药卫生—麻醉学]