胃镜喉罩用于老年患者上消化道内镜黏膜下剥离术的安全性研究  

Study on the safety of gastroscopic laryngeal mask for endoscopic submucosal dissection of upper digestive tract in elderly patients

作　　者：王鹏 黄庆先[2] 杨德军[2] Wang Peng;Huang Qingxian;Yang Dejun(Department of anesthesiology,Longhai hospital of Nanyang;Department of anesthesiology,the second people's hospital of Nanyang,Nanyang,Henan,473000,China)

机构地区：[1]南阳陇海医院麻醉科,河南南阳473000 [2]南阳市第二人民医院麻醉科

出　　处：《齐齐哈尔医学院学报》2022年第17期1655-1658,共4页Journal of Qiqihar Medical University

摘　　要：目的观察胃镜喉罩在老年患者上消化道黏膜下剥离术中的应用效果。方法选择2021年1—12月在本院进行内镜黏膜下剥离术老年患者60例作为研究对象,采用随机数表法分为胃镜喉罩组(W组)和气管插管组(E组)两组,每组各30例。W组根据患者体重置入3号或4号胃镜喉罩,E组插入7.5#气管导管。记录W组胃镜喉罩置入后平卧位、侧卧位纤维支气管镜评分;记录胃镜喉罩置入后平卧位、侧卧位、置入胃镜后的气道密闭压及平均气道压;记录诱导前(T_(0))、人工气道置入即刻(T_(1))、人工气道置入后1分钟(T_(2))、人工气道置入后5分钟(T_(3))、拔除人工气道即刻(T_(4))患者的HR、MAP,并于以上时点抽取患者静脉血标本测定肾上腺素(E)、去甲肾上腺素(NE)浓度;记录两组患者术中及拔除人工气道后返流、误吸的情况以及术后不良反应的发生情况。结果胃镜喉罩置入后平卧位、侧卧位、置入胃镜后的气道密闭压及平均气道压分别为[(27.3±2.4)VS(13.2±2.4)cmH_(2)O]、[(24.3±2.7)VS(11.6±2.1)cmH_(2)O]、[(29.3±2.9)VS(14.0±2.0)cmH_(2)O];与E组相比,W组患者T_(1)、T_(2)、T_(3)、T_(4)各时点HR、MAP及及血浆E、NE浓度均明显升高(P<0.05);与E组相比,W组患者术后咽痛、声嘶的发生率、拔除人工气道时间及PACU停留时间明显降低(P<0.05)。结论胃镜喉罩用于老年上消化道内镜黏膜下剥离术患者,可以降低气管插管诱发的应激反应,气道管理安全有效。Objective To observe the effect of gastroscopic laryngeal mask on submucosal dissection of upper digestive tract in elderly patients.Methods Sixty elderly patients underwentendoscopic submucosal dissectionin the hospital during January and December 2021 were enrolled as study objects,and they were randomly divided into gastroscopic laryngeal mask group(Group W)and endotracheal intubation group(Group E)according to random number table method,with 30 patients in each group.Patients in group W were placed with a no.3 or 4 gastroscopic laryngeal mask based on their body weight,and patients in group E were placed with a 7.5#endotracheal tube.The fiberoptic bronchoscopy scores of group W were recorded in supine position and lateral decubitus position after gastroscopy laryngeal mask placement.Airway sealing pressure and average airway pressure in supine position,lateral position and after endoscope placement were recorded.HR and MAP of patients before induction(T_(0)),immediately after artificial airway implantation(T_(1)),1min after artificial airway implantation(T_(2)),5min after artificial airway implantation(T_(3)),and immediately after artificial airway extraction(T_(4))were recorded,and the concentration of epinephrine(E)and norepinephrine(NE)in venous blood samples thsoe were collected at the above points were detected.The situation of reflux and aspiration during operation and after the removal of artificial airway and the occurrence of postoperative adverse reactions were recorded in the 2 groups.Results The airway sealing pressure and average airway pressure in supine position,lateral position and after endoscope placement were (27.3±2.4)VS(13.2±2.4)cmH_(2)O],(24.3±2.7)VS(11.6±2.1)cmH_(2)O],(29.3±2.9)VS(14.0±2.0)cmH_(2)O].Compared with group E,HR,MAP and plasma E and NE concentrations in group W were significantly increased at T_(1),T_(2),T_(3) and T_(4)(P<0.05).Compared with group E,the incidence of postoperative pharyngeal pain and hoarseness,artificial airway removal time and PACU residence time in g

关 键 词：胃镜喉罩 老年患者 内镜黏膜下剥离术 

分 类 号：R614[医药卫生—麻醉学]