鼻咽通气道用于脑功能区胶质瘤切除术中唤醒麻醉的临床观察

摘要

目的：探讨鼻咽通气道在神经外科脑功能区胶质瘤切除术中唤醒麻醉的有效性及可行性。方法：选择40例行脑功能区胶质瘤切除的患者，（ASA）Ⅰ－Ⅱ级，随机分为鼻咽通气道组（A 组）（n ＝20）和喉罩组（B组）（n ＝20）。静脉注射右美托咪定1μg／kg，持续10分钟后浓度调至0．2～0．7μg／（kg·h）持续泵注，瑞芬太尼为0．05～0．2μg／（kg·min），保留自主呼吸，待意识消失后，A 组置入鼻咽通气道，B 组置入喉罩。记录两组在麻醉诱导前（T0）、置入鼻咽通气道／喉罩后即刻（T1）、唤醒期间（T2）及拔出鼻咽通气道／喉罩后即刻（T3）的 BP、HR、SPO2和 RR 的变化、唤醒时间、术中恶心呕吐、上呼吸道梗阻和躁动的发生率、术后咽部不适、咽痛和吞咽困难的发生率。结果：T0时，A、B 两组 SBP、DBP、HR 和 RR 比较无差异（P ＞0．05）；T1和 T2时，A 组 SBP 和 DBP 明显低于 B 组；A 组 HR 和 RR 显著慢于 B 组，差异有统计学意义（P ＜0．05）。两组术中均未出现恶心呕吐。唤醒时间 A 组明显短于 B 组（P ＜0．05），躁动率也低于 B 组（P ＜0．05）。B 组术后咽部不适、咽痛和吞咽困难发生率均高于 A 组（P ＜0．05）。结论：鼻咽通气道应用于脑功能区胶质瘤切除术中唤醒麻醉，易于建立人工气道并可维持自主呼吸，对病人血流动力学影响较小，病人舒适度高，不良事件发生率低，是一种安全有效的麻醉方法。%Objective:To investigate the effectiveness and feasibility of nasopharyngeal airway (NPA)in intraop-erative wake -up test during excision of glioma in eloquent areas.Methods:Forty patients,ASA score Ⅰ -Ⅱ,sched-uled for brain regions glioma resection,were randomly divided into two groups:Nasopharyngeal airway group (group A,n =20)and laryngeal mask group (group B,n =20).Dexmedetomidine 1μg/kg and remifentanil 0.05 ~0.2μg/(kg·min)were injected intravenous.1 0 minutes later,the concentration of dexmedetomidine was down to 0.2 ~0.7μg/(kg·h)continuous pump injection.The spontaneous breathing was kept.After consciousness disappeared, nasopharyngeal airways were placed in the patients in group A and laryngeal masks were placed in the patients in group B.Blood pressure,heart rate,pulse oxygen saturation and respiratory rate were recorded before anesthesia induc-tion(T0),immediately after successful insertion of the airway(T1),awakening(T2)and immediately after removal of the airway(T3).The incidence rate of nausea and vomiting,upper airway obstruction and agitation during the opera-tion,the incidence rate of pharynx unwell,pharyngalgia and dysphagia after the operation and the anesthesia recovery period were recorded.Results:At the time point of T0,there were no differences in blood pressure,heart rate and re-spiratory rate between the two groups(P >0.05).At the time point of T1 and T2,compared with group B,the SBP and DBP in group A was deceased (P <0.05).The HR and RR in group A were significantly slowed down (P<0.05)compared with group B.Nausea and vomiting did not occur in both groups.In group A,the anesthesia recov-ery period was significantly shorter than that in group B (P <0.05).Agitation rate in group A was lower than that in group B (P <0.05).In group B,the incidence rate of nausea and vomiting,pharynx ministry unwell,pharyngalgia and dysphagia were higher than that in the group A (P <0.05).Conclusion:The application of nasopharyngeal airway in brain regions glioma resection during intraoperative wake -up test is easy to establish the airway,can maintain sponta-neous breathing,has more little influence on circulatory function,higher comfort and reduce complications,is an effi-cient and feasible anesthesia method.