ProSeal喉罩联合麻醉对老年妇女腹腔镜手术应激反应的影响

摘要

Objective:Exploring the feasibility and safety of the joint epidural anesthesia by the ProSeal laryngeal mask (the third generation esophageal drainage type laryngeal mask air duct,PLMA) in the geriatric laparoscopic gynecological operation. Methods:Dividing equally 100 cases patients at the age of 60-85 and with ASA grades ofⅡ-Ⅳat random into the group of ProSeal laryngeal mask joint epidural anesthesia (Group P,50 cases)and the group of tracheal intubation (Group T,50 cases). Recording the MAP and HR of both groups of patients at the time of their entrance into the operating room (T0),before the induced tube placement(T1),at the moment of inserting the laryngeal mask/tracheal intubation(T2),5 minute of inserting the laryngeal mask/tracheal intubation (T3),in the maintaining period of anesthesia for operation (T4) and immediately after pulling out the laryngeal mask/tracheal catheter (T5);5 minute before and after pneumoperitoneum,the Ppeak and PET (CO2) of both groups;the change in the blood gas analysis 5 minute before and after pneumoperitoneum of both groups;as well as the levels of AE,NE and DA detected by using high performance liquid chromatography and liquid chromatography analyser at T 0,T1,T2,T3, T4 and T5,two groups of patients after surgery to awakening to time ,and also the relevant complications of the patients. Results:The MAP and HR of two groups at T1 are lower than T0 (P<0.05). The MAP and HR of Group T at T2,T5 are significantly higher than those of Group P (P<0.05). The AE,NE and DA of two groups at T2,T5 are significantly rise (P<0.05). The AE,NE and DA of Group T at T2,T5 are significantly higher than those of Group P (P<0.05). The changes in IPPV of Ppeak,PET(CO2)、pH、Pa (O2) and Pa (CO2) are no difference between the two groups (P>0.05). The awakening time of Group P are significantly shorter than those of Group T (P<0.05). The complications in Group P are significantly fewer than those in Group T (P<0.05). Conclusions:The use of the PLMA joint anesthesia in the geriatric laparoscopic gynecologic operation is better than the tracheal intubation joint anesthesia,with positive features of being safe,stablied haemodynamics,slight fight-or-flight response, awakening time is short and less complications and is easy to operate ,so it deserves wide application.%目的：探讨ProSeal喉罩（第三代食管引流型喉罩通气道，PLMA）联合硬膜外麻醉在老年腹腔镜妇科手术中的可行性和安全性。方法：100例老年（60~85岁）妇科腹腔镜患者，美国麻醉医师协会（ASA）分级Ⅱ~Ⅳ级，随机均分成ProSeal喉罩联合硬膜外麻醉组（P组，50例）和气管插管联合硬膜外麻醉组（T组，50例）。记录2组患者入室时（T0）、诱导置管前（T1）、插入喉罩/气管插管即刻（T2）、插入喉罩/气管插管后5 min（T3）、手术麻醉维持期（T4）、拔出喉罩/气管导管后即刻（T5）的平均动脉压（MAP）和心率（HR）；2组患者气腹前后5 min的气道峰压（Ppeak）和呼气末二氧化碳分压[PET（CO2）]；2组患者气腹前后5 min血气分析的变化；以及2组患者于T0、T1、T2、T3、T4、T5时点应用高效液相色谱分析仪测定的血浆肾上腺素（AE）、去甲肾上腺素（NE）、多巴胺（DA）的水平；以及2组患者手术结束后的苏醒时间，并记录患者相关的并发症。结果：2组患者T1时点MAP、HR低于T0时（P＜0.05），T组患者在T2、T5时点MAP、HR高于P组（P＜0.05）；2组患者T2、T5时点AE、NE和DA升高（P＜0.05），T2、T5时点T组AE、NE和DA高于P组（P＜0.05），2组患者在间歇正压通气（IPPV）期间Ppeak、PET（CO2）、pH、动脉氧分压[Pa（O2）]和动脉二氧化碳分压[Pa（CO2）]变化差异无统计学意义（P＞0.05）；P组患者苏醒时间短于T组（P＜0.05）；P组患者并发症少于T组（P＜0.05）。结论：老年患者腹腔镜妇科手术中应用PLMA联合麻醉优于气管插管联合麻醉，具有安全性好，血流动力学平稳，应激反应轻微，苏醒时间短，并发症少的优点，操作简单，值得推广应用。