喉罩替換氣管導管在開顱手術蘇醒期中的應用研究

馬興對 吳靚 姬寧寧

摘 要：目的 比較開顱手術患者在蘇醒期將氣管導管替換成喉罩與未替換患者的血流動力學變化程度及嗆咳次數，以探究將氣管導管替換成喉罩是否有利于腦外科患者更加平穩安全的復蘇。方法 選擇我院2016年9月～2018年2月全麻下行顱骨切開手術的患者60例，隨機分為A組和B組，每組30例。A組行常規氣管插管，B組在手術結束后替換成喉罩。比較兩組患者各時間點的SAP、HR、MAP、MCA流速、rSO2，以及血漿去甲腎上腺素含量、發生嗆咳反應例數和降壓藥使用情況。結果 與術前T0相比，手術結束和拔管期間SAP、MAP、HR均升高（P<0.05）；拔管期間，A組在T2、T3、T4時間點的SAP、MAP、HR均高于B組，差異有統計學意義（P<0.05）。與術前T0相比，兩組患者手術后MCA流速和rSO2在蘇醒時均升高（P<0.05）；拔管期間，A組在T2、T3、T4時間點MCA流速和rSO2的升高均高于B組，差異有統計學意義（P<0.05）。兩組患者血漿去甲腎上腺素含量在蘇醒期均高于基礎水平（P<0.05），在T4時間點B組升高的程度小于A組（P<0.05）。A組發生嗆咳反應例數高于B組，差異有統計學意義（P<0.05）。A組使用降壓藥例數高于B組，差異有統計學意義（P<0.05）。結論 在腦外科手術后更換雙腔喉罩，可以維持更穩定的血流動力學，減少腦充血，同時減少全麻蘇醒后的咳嗽發生率。

關鍵詞：喉罩；腦外科手術；蘇醒；血流動力學

中圖分類號：R614.2 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.23.025

文章編號：1006-1959（2018）23-0091-05

Abstract：Objective To compare the degree of hemodynamic changes and the number of coughs in patients with craniotomy who were replaced with laryngeal masks and unreplaced patients during the recovery period to find out whether replacing the tracheal tube with a laryngeal mask is beneficial to patients with brain surgery. A smooth and safe recovery. Methods 60 patients with general anesthesia underwent craniotomy from September 2016 to February 2018 in our hospital were randomly divided into group A and group B， with 30 cases in each group. Group A was routinely intubated， and group B was replaced with a laryngeal mask at the end of the procedure. SAP， HR， MAP， MCA flow rate， rSO2， plasma norepinephrine content， cough response and antihypertensive drug use were compared between the two groups.Results Compared with preoperative T0， SAP， MAP and HR were increased during the end of operation and extubation （P<0.05）. During extubation， SAP， MAP and HR were higher in group A at T2， T3 and T4 higher than group B， the difference was statistically significant（P<0.05）. Compared with preoperative T0， both MCA flow rate and rSO2 increased after surgery（P<0.05）. During extubation， group A had increased MCA flow rate and rSO2 at T2， T3 and T4. higher than group B， the difference was statistically significant（P<0.05）. The plasma norepinephrine levels in the two groups were higher than the basal level during the recovery period （P<0.05），the degree of elevation in group B was less than that in group A at time T4 （P<0.05）. The number of cough reaction in group A was higher than that in group B， and the difference was statistically significant （P<0.05）. The number of antihypertensive drugs in group A was higher than that in group B， and the difference was statistically significant（P<0.05）. Conclusion Replacement of the double-chamber laryngeal mask after brain surgery can maintain more stable hemodynamics， reduce cerebral congestion， and reduce the incidence of cough after general anesthesia.

Key words：Laryngeal mask；Brain surgery；Revival；Hemodynamics

腦外科手術是通過外科手段對腦腫瘤、腦外傷等進行治療，臨床效果較好。但腦外科手術患者的并發癥多，血流動力學波動大，因此對麻醉管理要求高，要求麻醉誘導和維持盡量減少血流動力學的波動，減少應激反應的發生，尤其是在蘇醒拔管期間的血壓控制對于術后并發癥的預防尤為重要。經口氣管插管是腦外科手術術中氣道管理的主要方式，氣管插管可以在長時間手術尤其是頭頸部手術時提供充足的通氣。然而，在非神經外科手術患者的研究中發現，氣管插管相比較于喉罩會導致劇烈的血流動力學效應（血壓，心率等）以及循環系統中兒茶酚胺的含量（尤其是去甲腎上腺素）[1，2]。這些差異在蘇醒和拔管時更加顯著。本研究旨在探討患者術后深麻醉下拔管更換喉罩通氣，觀察其在拔管期間的影響，為后期的臨床決策提供一定的參考。……