喉罩全麻与蛛网膜下腔阻滞在宫腔镜手术中的应用比较(1)
[摘要] 目的 探讨喉罩全麻与蛛网膜下腔阻滞(腰麻)在宫腔镜手术中的应用效果。 方法 选取2015年8～12月于郑州大学第三附属医院行宫腔镜手术的100例患者为研究对象，采用随机数字表法将患者分为两组：喉罩组(LMA组)和蛛网膜下腔阻滞组/腰麻组(SA组)，每组各50例。LMA组予以长托宁0.5 mg，地塞米松10 mg，咪达唑仑2 mg，舒芬太尼0.3 μg/kg，丙泊酚2～2.5 μg/kg静脉诱导后置入喉罩，吸入七氟烷1.5%～2%维持麻醉，手术结束后停止七氟烷的吸入，高流量吸氧将患者肺内七氟烷排出体外，待患者自主呼吸恢复、潮气量适宜后叫醒患者，拔出喉罩。SA组患者于左侧卧位L3～4间隙通过针内针技术穿刺，于蛛网膜下腔注入0.5%罗哌卡因2.5 mL，调整麻醉平面T8～T6。观察记录麻醉实施前、麻醉后5 min、手术开始即刻两组患者的平均动脉压(MAP)及心率(HR)，记录患者从麻醉开始到手术开始的时间(T值)，随访观察两组患者的肛门排气时间、下床活动时间、恶心呕吐，及相关麻醉并发症的发生情况。 结果 麻醉实施前两组患者MAP、HR值比较差异无统计学意义(P > 0.05)；与麻醉实施前比较，麻醉后5 min SA组患者MAP明显降低，HR明显升高，差异均有统计学意义(P < 0.05)；与麻醉实施前比较，麻醉后5 min LMA组患者HR值明显下降(P < 0.05)，而MAP下降不明显(P > 0.05)。麻醉后5 min和手术开始即刻，SA组患者MAP明显低于LMA组，HR明显高于LMA组，差异均有统计学意义(P < 0.05)。LMA组患者T值[(5.2±0.8)min]较SA组[(12.2±0.7)min]明显缩短(P < 0.05)。LMA组患者术后肛门排气时间及下床活动时间明显少于SA组，术后恶心、呕吐发生率明显低于SA组，差异均有统计学意义(P < 0.05)。 结论 喉罩全麻用于宫腔镜手术麻醉患者血流动力学更稳定、舒适，术后恢复更快。
[关键词] 喉罩全麻；蛛网膜下腔阻滞；宫腔镜手术；喉罩
[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210(2016)05(a)-0061-04
[Abstract] Objective To compare the effects of LMA general anesthesia and subarachnoid block (spinal anesthesia) in hysteroscopic operations. Methods 100 patients from August to December 2015 in the Third Affiliated Hospital of Zhengzhou University were chosen as study objects， and they were randomly divided into two groups according to the random number tables. Laryngeal mask airway (LMA) group and subarachnoid block/spinal anesthesia (SA) group， with 50 patients in each group. Patients of the LMA group were given the vein induced of Penehyclidine Hydrochloride 0.5 mg， Hexadecadral 10 mg， Midazolam 2 mg， Sufentanil 0.3 μg/kg， Propofol 2-2.5 μg/kg before LMA， after which 1.5%-2% Sevoflurane was inhaled to maintain anesthesia， and Sevoflurane was cut off when surgery was over， which was followed by high flow of oxygen inhalation to expel Sevoflurane from patient's lungs. When autonomous respiration came back with a proper tidal volume， patient was woken up and the LMA was taken out. In SA group， SA was applied through L3-4 gap of patients in left lateral position， and 0.5% Ropivacaine 2.5 mL was injected into subarachnoid space with the anesthesia level controlled to T8-T6. The mean arterial pressure (MAP) and heart rates (HR) of patients were observed and recorded at the time before the implementation of anesthesia， 5 min after anesthesia and beginning of surgery immediately in both groups. The times from anesthesia to surgery starting (T value) were recorded also. Patients of two groups were followed up， time of anal exhaust， ambulation time， presence of nausea and vomiting， and related complications in anesthesia were recorded. Results Value of MAP， HR of patients in the two groups before anesthesia had no statistical significance difference (P > 0.05). Compared with before anesthesia， MAP of the SA group declined statistically 5 min after anesthesia， HR risen dramatically， the differences were statistical significant (P < 0.05)； HR in the LMA group declined remarkably (P < 0.05)， but MAP was not obvious (P > 0.05). At 5 min after anesthesia and the very moment of the surgery began， MAP was statistically lower and HR was statistically higher in the SA group than those of the LMA group， showed significant differences (P < 0.05). T value in the LMA group [(5.2±0.8) min] was statistically shorter than that in the SA group [(12.2±0.7) min] (P < 0.05). Time of anus exhaust and off-bed activity of the LMA group were less than that of the SA group after surgery， the incidence of postoperative nausea and vomiting in the LMA group was significantly lower than those in the SA group， the differences were statistical significant (P < 0.05). Conclusion LMA general anesthesia is more stable laryngeal mask airway and comfortable in haemodynamics during anesthesia of hysteroscope operation， and recovered quicker after operation. (吴艳玲 党博 符强 魏晓永 李黎 姜丽华)
[关键词] 喉罩全麻；蛛网膜下腔阻滞；宫腔镜手术；喉罩
[中图分类号] R614 [文献标识码] A [文章编号] 1673-7210(2016)05(a)-0061-04
[Abstract] Objective To compare the effects of LMA general anesthesia and subarachnoid block (spinal anesthesia) in hysteroscopic operations. Methods 100 patients from August to December 2015 in the Third Affiliated Hospital of Zhengzhou University were chosen as study objects， and they were randomly divided into two groups according to the random number tables. Laryngeal mask airway (LMA) group and subarachnoid block/spinal anesthesia (SA) group， with 50 patients in each group. Patients of the LMA group were given the vein induced of Penehyclidine Hydrochloride 0.5 mg， Hexadecadral 10 mg， Midazolam 2 mg， Sufentanil 0.3 μg/kg， Propofol 2-2.5 μg/kg before LMA， after which 1.5%-2% Sevoflurane was inhaled to maintain anesthesia， and Sevoflurane was cut off when surgery was over， which was followed by high flow of oxygen inhalation to expel Sevoflurane from patient's lungs. When autonomous respiration came back with a proper tidal volume， patient was woken up and the LMA was taken out. In SA group， SA was applied through L3-4 gap of patients in left lateral position， and 0.5% Ropivacaine 2.5 mL was injected into subarachnoid space with the anesthesia level controlled to T8-T6. The mean arterial pressure (MAP) and heart rates (HR) of patients were observed and recorded at the time before the implementation of anesthesia， 5 min after anesthesia and beginning of surgery immediately in both groups. The times from anesthesia to surgery starting (T value) were recorded also. Patients of two groups were followed up， time of anal exhaust， ambulation time， presence of nausea and vomiting， and related complications in anesthesia were recorded. Results Value of MAP， HR of patients in the two groups before anesthesia had no statistical significance difference (P > 0.05). Compared with before anesthesia， MAP of the SA group declined statistically 5 min after anesthesia， HR risen dramatically， the differences were statistical significant (P < 0.05)； HR in the LMA group declined remarkably (P < 0.05)， but MAP was not obvious (P > 0.05). At 5 min after anesthesia and the very moment of the surgery began， MAP was statistically lower and HR was statistically higher in the SA group than those of the LMA group， showed significant differences (P < 0.05). T value in the LMA group [(5.2±0.8) min] was statistically shorter than that in the SA group [(12.2±0.7) min] (P < 0.05). Time of anus exhaust and off-bed activity of the LMA group were less than that of the SA group after surgery， the incidence of postoperative nausea and vomiting in the LMA group was significantly lower than those in the SA group， the differences were statistical significant (P < 0.05). Conclusion LMA general anesthesia is more stable laryngeal mask airway and comfortable in haemodynamics during anesthesia of hysteroscope operation， and recovered quicker after operation. (吴艳玲 党博 符强 魏晓永 李黎 姜丽华)