海南医科大学学报

目的:观察喉罩联合气管插管对上腹部手术麻醉患者的应激影响。方法:选取我院行上腹手术患者40例,随机分为观察组与对照组,观察组采用喉罩联合气管插管进行呼吸道管理,对照组采用气管插管进行呼吸道管理。观察两组患者入室时(T0),喉罩/插管前(T1)、喉罩/插管即刻(T2)、喉罩/插管后3min(T3)患者的各项生命体征及应激变化。结果:观察组T2时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)显著低于对照组(P<0.05);两组T1、2、3时血氧饱和度(SpO2)均显著高于T0时(P<0.05),但组间比较无统计学差异(P>0.05);观察组T2、3时心脏指数(CI)、心输出量(CO)较T0时显著升高(P<0.05),外周血管阻力(SVR)、左心做功(LCW)显著下降(P<0.05);T2时CO、CI、SVR、LCW与T0时比较无统计学差异(P>0.05);对照组T1、3时CO、CI显著高于T0时(P<0.05),SVR、LCW较T0时明显下降(P<0.05),T2时CO、CI显著低于T0时(P<0.05);观察组T2时CO、CI显著高于对照组,SVR、LCW显著低于对照组(P<0.05);两组各时间点麻醉深度(BIS)比较无统计学差异(P>0.05)。结论:喉罩联合气管插管可降低腹部手术患者麻醉期高应激状态,稳定血流变学指标,减少心血管不良事件的发生,值得临床推广应用。

Objective:To observe the stress effect of laryngeal mask in combined with tracheal intubation on the anesthesia patients underwent upper abdomen surgery.Methods:A total of 40 patients underwent upper abdomen surgery and admitted in our hospital from October,2012 to May,2013 were enrolled in our study and randomized into the observation group and the control group.The patients in the observation group were given laryngeal mask in combined with tracheal intubation for airway management,while the patients in the control group were only given tracheal intubation for airway management.The patients' various vital signs and stress changes before entering the operation room(T0),the time before laryngeal mask and tracheal intubation(T1),the immediate time of laryngeal mask and tracheal intubation(T2),and 3min after laryngeal mask and tracheal intubation(T3)in the two groups were observed.Results:The SBP,DBP,MAP and HR at the time of T2 in the observation group were significantly lower than those in the control group(P<0.05);the SpO2 at the time of T1,T2,and T3 was significantly higher than that at the time of T0(P<0.05);but the comparisons of the above indicators between the two groups were not statistically different(P>0.05).The CO and CI at the time of T2 and T3in the observation group were significantly increased when compared with those at the time of T0(P<0.05),but SVR and LCW were significantly reduced(P<0.05);the comparisons of CO,CI,SVR and LCW between the time of T2 and T0were not statistically different(P>0.05).The CO and CI at the time of T1 and T3in the control group were significantly higher than those at the time of T0(P<0.05);SVR and LCW were significantly reduced when compared with those at the time of T0(P<0.05);CO and CI at the time of T2 were significantly lower than those at the time of T0(P<0.05).The CO and CI at the time of T2 in the observation group were significantly higher than those in the control group(P<0.05);SVR and LCW were significantly lower than those in the control group(P<0.05).There was not a statistical difference of BIS value at various timing points between the two groups(P>0.05).Conclusions:Laryngeal mask in combined with tracheal intubation can reduce the high stress status at the anesthesia in the patients underwent abdomen surgery,stabilize the hemorheology indicators,and reduce the occurrence of cardiovascular adverse reactions;therefore,it deserves to be widely recommended in the clinic.