摘要
目的观察喉罩通气麻醉在高龄患者内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)中的应用价值。方法对60例实施ERCP的老年患者(70~85岁),随机分为喉罩通气麻醉(LMA组,n=30)和传统面罩吸氧通气麻醉(M组,n=30),2组患者均静脉注射地佐辛5 mg,丙泊酚1.5 mg·kg^(-1),LMA组待患者入睡睫毛反射消失,下颌松弛后即置入喉罩行辅助呼吸,M组用面罩辅助呼吸。2组均根据检查时间和患者体动情况追加丙泊酚。记录手术开始前(T0),检查镜通过咽喉后(T1),手术开始10 min(T2),术毕(T3)4个时点患者血压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)、术中患者呛咳、体动和缺氧情况、术者满意度等。结果 LMA组在T1、T2时点MAP显著低于M组[T1:(98.7±13.6)mm Hg vs.(120.0±9.6)mm Hg,t=-6.928,P=0.000;T2:(99.6±13.3)mm Hg vs.(117.4±12.3)mm Hg,t=-7.649,P=0.000]。LMA组在T1、T2时点HR显著低于M组[T1:(81.6±14.0)次·min^(-1)vs.(92.5±15.0)次·min^(-1),t=-2.887,P=0.005;T2:(80.7±10.8)次·min^(-1)vs.(92.1±16.3)次·min^(-1),t=-3.177,P=0.002];LMA组Sp O2在T1、T2、T3时点显著高于M组[T1:(99.6±0.6)%vs.(94.7±7.2)%,t=3.715,P=0.000;T2:(99.6±0.6)%vs.(93.5±6.2)%,t=5.365,P=0.000;T3:(99.0±2.3)%vs.(95.1±4.7)%,t=4.070,P=0.000]。LMA组ERCP操作时间明显短于M组时间[(47.7±10.4)min vs.(55.8±14.6)min,t=-2.461,P=0.017],但苏醒时间较M组明显延长[(7.5±4.9)min vs.(4.6±3.2)min,t=2.682,P=0.010]。LMA组患者术中呛咳和低氧血症发生率更低(呛咳:0例vs.7例,P=0.005;低氧血症:0例vs.5例,P=0.024),术者满意度更高[(1.0±0.1)分vs.(0.8±0.3)分,t=3.459,P=0.001]。结论喉罩通气麻醉用于高龄病人的ERCP可取得满意效果,且安全性更高。
Objective To observe the application effect of general anesthesia with laryngeal mask ventilation in endoscopic retrograde cholangiopan creatography（ ERCP） in elderly patients. Methods A total of 60 elderly patients receiving ERCP were randomly divided into 2 groups by using a random number table： general anesthesia with laryngeal mask ventilation（ LMA group,n =30） and mask ventilation（ M group,n = 30）. Both groups were given dezocine 5 mg and propofol 1. 5 mg·kg- 1. A laryngeal mask was used in the LMA group after the disappearance of eyelash reflex and jaw relaxation. A mask was used in the M group. Propofol could be increased for condition. The BP,HR,ECG,Sp O2 were recorded before anesthetic induction（ T0）,immediately after the endoscope passing through the throat（ T1）,10 min after operation（ T2） and at the end of operation（ T3）. The development of hypoxemia,operator satisfaction scores,side effects,operation time and anesthesia time were recoded. Results The mean arterial pressures in the LMA group were significantly lower than those in the M group at T1 [（ 98. 7 ± 13. 6） mm Hg vs.（ 120. 0 ± 9. 6） mm Hg,t =- 6. 928,P = 0. 000] and T2 [（ 99. 6 ± 13. 3） mm Hg vs.（ 117. 4 ± 12. 3） mm Hg,t =- 7. 649,P = 0. 000]. The heart rates in the LMA group were significantly lower than those in the M group at T1 [（ 81. 6 ± 14. 0） beats / min vs.（ 92. 5 ± 15. 0）beats / min,t =- 2. 887,P = 0. 005] and T2 [（ 80. 7 ± 10. 8） beats / min vs.（ 92. 1 ± 16. 3） beats / min,t =- 3. 177,P = 0. 002].The Sp O2 levels in the LMA group at T1,T2,and T3 were higher than those in the M group with statistical differences [T1：（ 99. 6 ±0. 6） % vs.（ 94. 7 ± 7. 2） %,t = 3. 715,P = 0. 005; T2：（ 99. 6 ± 0. 6） % vs.（ 93. 5 ± 6. 2） %,t = 5. 365,P = 0. 000; T3：（ 99. 0 ± 2. 3） % vs.（ 95. 1 ± 4. 7） %,t = 4. 070,P = 0. 000]. The operation time was shorter in the LMA group than those in the M group [（ 47. 7 ± 10. 4） min vs.（ 55. 8 ± 14. 6） min,t =- 2. 461,P = 0. 017],while the emergence time was lorger[（ 7. 5 ± 4. 9）min vs.（ 4. 6 ± 3. 2） min,t = 2. 682,P = 0. 010]. The incidence of intraoperative cough and the incidence of hypoxemia were much lower in the LMA group than those in the M group（ intraoperative cough： 0 vs. 7 cases,P = 0. 005; hypoxemia： 0 vs. 5 cases,P =0. 024）. The operator satisfaction scores were higher in the LMA group [（ 1. 0 ± 0. 1） points vs.（ 0. 8 ± 0. 3） points,t = 3. 459,P =0. 001]. Conclusion General anesthesia with laryngeal mask ventilation in ERCP in elderly patients shows satisfactory anesthesia effect.
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第6期498-501,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
内镜逆行胰胆管造影
麻醉
喉罩
Endoscopic retrograde cholangiopancreatography
Anesthesia
Laryngeal mask ventilation
