Proseal喉罩并全靜脈麻醉在老年人手術中的應用

[摘要] 目的 評價Proseal喉罩并全靜脈麻醉用于老年患者手術時的安全性及有效性。 方法 選擇ASAⅠ～Ⅱ級、年齡≥60歲擇期手術老年患者60例，隨機分為兩組，每組30例。記錄兩組患者插管（罩）前（T1）、插管（罩）即刻（T2）、插管（罩）后3 min（T3）、停藥即刻（T4）、拔管（罩）即刻（T5）、拔管（罩）后3 min（T6）的平均動脈壓和心率變化。記錄兩組患者插（拔）管時嗆咳反應及術后不良反應的發生情況。 結果 喉罩組插（拔）罩前后的HR、MAP無明顯變化，氣管插管組拔管即刻HR、BP顯著高于拔管前（P<0.05）； 氣管插管組嗆咳反應、咽痛、聲嘶、惡心嘔吐發生率明顯高于喉罩組（P<0.01）。 結論 Proseal喉罩并全靜脈麻醉具有置入方便、圍麻醉期循環穩定、不良反應少的優點，用于老年患者手術較氣管插管全麻更安全舒適。

[關鍵詞] 老年人；Proseal喉罩；全靜脈麻醉

[中圖分類號] R614.2+4 [文獻標識碼] B [文章編號] 2095-0616（2012）22-94-02

Application of proseal laryngeal mask combined with total intravenous anesthesia in surgery for elder patients

WANG Suizhi LI Yingying LIU Xianqiong LU Xiaomin GUO Sanming

Department of Anesthesiology，People's Hospital of Ji'an Central，Ji'an 343000，China

[Abstract] Objective To evaluate the safety and effectiveness of proseal laryngeal mask combined with total intravenous anesthesia in the surgery for elder patients. Methods Sixty elder patients with ASA gradeⅠ-Ⅱ and age≥60 years，were randomly divided into two groups，with 30 patients in each group respectively. The mean artery pressure（MAP）and heart rate（HR）changes before intubation（mask insetion）（T1），at immediate intubation（mask insetion）（T2），3 minutes after intubation （mask insetion）（T3），at immediate drug withdrawal （T4），at immediate extubation（mask removal）（T5） and 3 minutes after extubation（mask removal）（T6）of both groups were recorded. The occurrence of choking cough response and postoperative adverse reactions at intubation（extubation）of both groups was recorded. Results In the laryngeal mask group，HR and MAP did not change significantly before and after mask insertion（removal），but in the tracheal intubation group，HR and BP at immediate extubation were significantly higher than those before extubation（P<0.05）.The incidence rates of choking cough reaction，pharyngalgia，hoarseness，nausea and vomiting of the tracheal intubation group were significantly higher than those of the laryngeal mask group（P<0.01）. Conclusion Proseal laryngeal mask combined with total intravenous anesthesia has the advantages of convenient placement，stable circulation in perianaesthetic stage and few adverse reactions，thereby more suitable for the surgery for elder patients than general anesthesia by tracheal intubation.

[Key words] Elder patient；Proseal laryngeal mask；Total intravenous anesthesia

隨著社會的老齡化以及人民生活水平的提高，對醫療安全及質量的要求會越來越高，老年患者機體組織器官功能發生衰老性退變，心肺儲備功能減退，對麻醉手術耐受力和適應力差。傳統的氣管插管時患者血流動力學波動大，術后并發癥多。喉罩是近年來使用的一種新型通氣道，是介于氣管插管與面罩之間的工具，具有不需喉鏡、操作簡便、容易置入、插管反應小、術后不良反應少等特點。為此，自2012年3～6月筆者將Proseal喉罩（proseal laryngeal mask airway，PLMA）并全靜脈麻醉用于老年患者手術探討其安全性及有效性。

1 資料與方法

1.1 一般資料

選擇ASAⅠ～Ⅱ級老年患者擇期手術60例，其中男23例，女37例，年齡60～84歲，平均（73±11）歲，體重 42～78 kg，平均（58±15）kg， 隨機分為兩組，每組30例。……