喉罩在喉气管裂开成形术中的应用

摘要

Objective:By observing the influencing of laryngeal mask in the laryngeal tracheal rupture for patients'blood flow dynamics and the stress hormone levels,to explore the clinical value of laryngeal mask in the laryngeal tra-cheal rupture.Methods:Forty -eight patients,ASA I to Ⅲand scheduled for laryngeal tracheal rupture,were random-ly divided into two groups:Laryngeal mask group(group A,n =24)and trachea incision under local anesthesia group (group B,n =24).In group A,proSeal laryngeal mask were performed after anesthesia induction,then anesthesia ma-chine controlled breath.After tracheotomy,endotracheal tube was inserted and anesthesia machine controlled breath. Then pull out the laryngeal mask.In group B,tracheotomy was performed after local anesthesia and then endotracheal tube intubation.Anesthesia machine controlled breath.The mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2 )were investigated and recorded on the following time points:Prior to the inductional anesthe-sia(T0),after LMA or endotracheal tube intubation(T1),10min after PLMA or endotracheal tube intubation(T2), 30min after PLMA or endotracheal tube intubation(T3).The amount of bleeding,time using,aspiration and tracheo-spasm were recorded in tracheotomy between the two groups.Levels of stress hormones were recorded at the following time points:Prior to the inductional anesthesia(T4),after LMA or endotracheal tube intubation(T5),after laryngeal tracheal rupture plasty(T6)and 30min after laryngeal tracheal rupture plasty(T7).Results:In group B,the MAP and HR at T1 point were significantly higher than the T0 point(P <0.01).T2 and T3,compared with T0,there was no statistically significant difference(P >0.05).At T1 point,the MAP and HR in group B were significantly higher than that of group A(P <0.01).Compared with group B,bleeding volume,time using and the incidence of aspiration and tracheospasm were less in group A(P <0.05).Compared with T4,blood glucose was significantly higher at other time points(P <0.05).In group A,blood glucose to rise was statistically significant at the T6 point compared with that of T4 point (P <0.01).In group B,the time point of T6 and T7 blood glucose were higher than that of group A(P<0.05).At T6 time point,the serum cortisol was higher than T4(P <0.05).At T7 point,compared with B there was statistically significant in group A(P <0.05).Conclusion:Compared with tracheotomy after local anesthesia and then inserting into endotracheal tube,PLMA applied to laryngeal tracheal rupture for patients,has less influence on hemo-dynamics,less adverse reaction,cause of less stress reaction,at the same time can guarantee the effective ventilation, providing security for laryngotracheal stenosis patients.%目的：观察喉罩在喉气管裂开成形术中对病人血流动力学和应激激素水平的影响，评价喉罩在喉气管裂开成形术中的应用价值。方法：选择48例 ASAⅠ－Ⅲ级的喉气管狭窄择期手术的病人，按照随机数字表法分为喉罩组（A 组）和局麻气管切开组（B 组），每组24例。A 组：快速麻醉诱导后置入双管型喉罩，固定后行麻醉机控制呼吸，待气管切开后台上置入气管导管，拔除喉罩，通过气管导管行控制呼吸后继续手术。B组：先在局部麻醉下行气管切开置入气管导管，固定后行麻醉机控制呼吸继续手术。观察两组在麻醉诱导前（T0）、置入喉罩或气管切开置入气管导管即刻（T1）、置入喉罩后或气管切开置入气管导管后10min（T2）和置入喉罩后或气管切开置入气管导管后30min（T3）的 MAP、HR、SpO2变化。记录两组气管切开术中出血量、气管切开所需时间、误吸和气管痉挛的发生率。观察麻醉前（T4）、置入喉罩后或气管切开置入气管导管后即刻（T5）、喉气管裂开成形术术毕即刻（T6）和术后30min（T7）4个时点的应激激素水平。结果：B 组患者在 T1时点的 MAP、HR 明显高于 T0时点（P ＜0．01），T2、T3时点与 T0时点差异无统计学意义（P ＞0．05）；B组与 A 组比较，T1时点的 MAP、HR 明显升高（P ＜0．01）。与 B 组病人相比，A 组病人气管切开术的出血量明显减少，气管切开术时间缩短，未发生误吸及气管痉挛，不良事件少（P ＜0．05）。B 组自插管后各时间点的血糖均明显高于麻醉前（P ＜0．05），A 组在手术结束时血糖上升与麻醉前比较差异有统计学意义（P ＜0．01）；B组在 T6和 T7时点的血糖上升明显高于 A 组（P ＜0．05）。两组血皮质醇在 T6时点均高于 T4时点（P ＜0．05）；T7时点的血皮质醇 A 组下降，而 B 组继续上升，B 组与 A 组比较差异有统计学意义（P ＜0．05）。结论：与局部麻醉下气管切开置入气管导管通气相比，双管型喉罩通气应用于喉气管裂开成形术对患者血流动力学干扰小，不良反应少，引起的应激反应轻，同时能保证有效地通气，为喉气管狭窄患者提供了安全保障。