摘要
目的观察甲状腺切除手术中采用无肌松剂喉罩置入复合颈浅丛麻醉效果。方法19-55岁,ASAⅠ-Ⅱ级择期甲状腺切除术患者70例,随机均分为气管导管组(T组)和喉罩组(L组)。T组记录各组气管插管或喉罩置入前(T0)、置入后即刻(T1)、置入后3 min(T2)、切皮时(T3)、甲状腺叶切除时(T4)、缝合皮肤(T5)和拔除喉罩(T6)的SBP、DBP和HR。观察手术中麻醉效果以及术后呛咳、苏醒期躁动、恶心呕吐、声嘶、咽喉疼痛的发生率。结果两组在T0、T5时的SBP、DBP和HR差异无统计学意义,T组在T1、T2、T3、T4、T6时的SBP、DBP和HR明显高于L组(P<0.05),两组组内各时间点与组内T0相比T组在T1、T2、T3、T4、T6时SBP、DBP和HR明显高于T0(P<0.05),L组则差异无统计学意义,且麻醉效果满意。术后T组切口痛、苏醒期躁动、术后咽痛例数明显多于L组(P<0.05)。结论颈浅丛阻滞复合非肌松喉罩置入较气管内插管全麻方法优点是:操作简便,通气可靠,对心血管系统刺激性小,术后并发症少。
Objective To investigate the effects of inserting laryngeal mask without muscle relaxation combined with shallow cervical plexus block in patients undergoing thyroidectomy. Methods 70 patients undergoing selective thyroidectomy were enrolled in the study. The patients were randomized to receive either LMA ventilation （group L） or endotracheal intubation （group T）. Group L were poured mixed hquor included 2% hdocaine7.5ml and 0.75 ropivacaine 7.5ml into each of cervical plexus, then the blockage effect was measured, after 3 -5 minutes oxygen intakin, propofol 3mg/kg, fentanyl 3μg/ kg, and do not give patients ventilatory support, when the effect was satisfied, inserted size 4 single -tube laryngeal mask （weight 50 -70kg） or size 5 （weight 〉 70kg）, then give cis - atracurium 5 rag, start mechanical ventilation. Group T was induced with propofol 3mg/kg , fentanyl 3ttg/kg and cis - atracurium O. 2- 0.3mg/kg, then start tracheal intubation. Use pump- introduction of propofol and remifentanil to maintain anaesthesia. SBP, DBP, and HR were recorded when before Laryngeal mask insertion or intubation （To ）, immediately after that （T1 ）, 3 rain after Laryngeal mask insertion or intubation （ T2 ） , cutting skin （ T3 ）, thyroidectomize （ T4 ）, sature skin （ T5 ）, immediately after laryngeal mask withdrawal or extubation （T6 ）. Anesthesia effects during operation was observed. Results There is no obvious difference among SBP, DBP and HR at T0,T5 between two groups. SBP, DBP and HR in group T were higher than those in group L at T1 , T2, T3, T4 and T6 （P 〈 0.05）. The changes in SBP DBPand HR in group T at T1, T2, T3, T4, and T6 were more than those at T0. But there is no obvious difference in group L on all time points, and the anesthesia effect is satisfied. The number of incision pain, restlessness in analepsia period and throat feels unwell in group T was more than those in group L （P 〈 0. 05）. Conclusion It is a easily process of inserting laryngeal mask without muscle relaxation combined with shallow cervical plexus block. The ventilation effect is reliable. The stimulation to the cardiovascular system is small. The postoperative complications are fewer.
出处
《宁夏医学杂志》
CAS
2010年第3期248-250,共3页
Ningxia Medical Journal
关键词
喉罩置入
颈浅丛阻滞
气管插管
甲状腺切除术
术后并发症
Laryngeal mask insertion
Shallow cervical plexus block
Tracheal intubation
Thyroidectomy
Postoperative complication
