摘要
目的与传统气管插管比较,探讨一次性双管喉罩(LMA SupremeTM)对肾移植术全麻患者血流动力学和呼吸道阻力的影响,评价其在肾移植手术应用的效果与安全性。方法 58例择期全麻下肾移植手术患者,ASA III～IV级,随机分为喉罩组(L组)和气管插管组(E组),每组29例。分别记录插入喉罩/气管导管前(T0)、插入喉罩/气管导管后1 min(T1)、3 min(T2)和拔喉罩/气管导管前(T3)、拔喉罩/气管导管后1 min(T4)、3 min(T5)的SBP、DBP、HR,以及T1、T2、T3时点平均气道压(Pmean)、气道峰压(Ppeak)、呼气末二氧化碳分压(PETCO2),统计置入喉罩的成功率及并发症的发生率。结果 L组T0～T5时点HR、SBP、DBP平稳,E组T1、T3、T4时点HR、SBP、DBP明显高于T0时点,组间比较差异明显(P<0.05)。T1～T3时点L组Pmean、Ppeak明显低于E组(P<0.05),T1～T3时点PETCO2的组间差异均无统计学意义(P>0.05)。术后咽部不适L组3例(10.34%),E组8例(27.59%),差异有统计学意义(P<0.05)。结论肾移植手术应用SupremeTM喉罩全麻心血管刺激反应较气管插管全麻小,通气效果确切、安全,并发症少。
Objective For the evaluating purpose,a study was designed to compare the safety and efficacy when the laryngeal mask airway（LMA） SupremeTM was used during the kidney transplant operation under the general anesthesia circumstance,which was as the replacement for the endotracheal tube（ETT）.Methods All fifty eight patients,ASA III-IV,who required kidney transplant with general anaesthesia,were randomized to laryngeal mask group（Group L） and endotreacheal tube group（Group E）.The values of SBP,DBP and HR were all recorded respectively before intubation of ETT or LMA（T0）,at one minute after intubation of ETT or LMA（T1）,at three minutes after intubation of ETT or LMA（T2）,before extubation of ETT or LMA（T3）,at one minute after extubation of ETT or LMA（T4）,at three minutes after extubation of ETT or LMA（T5）.In the meantime,the values of mean airway pressure（Pmean,peak airway pressure（Ppeak）and partialpressure end-tidal carbon dioxide（PETCO2） were recorded from T1 to T3..Moreover,statistical analysis was used to measure the successful rates of LMA placement and complication incidences of both LMA and ETT were assessed.Results The values of SBP,DBP and HR of Group L remained comparatively steady from T0 to T5,however,the values of SBP,DBP and HR of Group E at T1,T3 and T4 were significantly higher than the values at T0.There were significant differences in these two groups.From time points T1 to T3,Group L had much lower values of Pmean Ppeak than Group E while the value of PETCO2 had no significant difference between the two groups.Postoperative throat discomfort was found in three cases in Group L and eight cases in Group E（10.34% vs 27.59%,P0.05）.Conclusion The SupremeTM laryngeal mask proves to be a suitable and safe alternative to ETT for airway management for the patients receiving general anesthesia undergoing kidney transplantation.
出处
《安徽医学》
2012年第4期451-454,共4页
Anhui Medical Journal
关键词
喉罩
气管插管
肾移植术
气道管理
血流动力学
Laryngeal mask
Endotracheal tube
Kidney transplantation
Airway management
Hemodynamics
作者简介
通信作者：方才
