本文選題：老年人 + 麻醉��； 參考：《河北醫(yī)藥》2016年05期

【摘要】：目的探討在老年患者側(cè)臥位髖部手術(shù)中喉罩通氣全身麻醉呼吸和循環(huán)管理的方法。方法 52例老年髖部手術(shù)患者隨機(jī)分配進(jìn)入L組(喉罩通氣全身麻醉)和T組(氣管插管),每組26例。L組采用微泵注射結(jié)合靜脈推注的慢誘導(dǎo)模式;術(shù)中持續(xù)靜脈泵注丙泊酚和瑞芬太尼維持,根據(jù)手術(shù)刺激強(qiáng)度復(fù)合七氟醚吸入麻醉;體位變動(dòng)時(shí)短時(shí)間脫管防止喉罩松動(dòng),側(cè)臥位后重新固定螺紋管并確認(rèn)喉罩位置。觀察和記錄入室后10 min(T0)、插管(喉罩)前(T1)、插管(喉罩)后1 min(T2)、插管(喉罩)后5 min(T3)、插管(喉罩)后8 min(T4)、切皮(T5)、拔出氣管導(dǎo)管或喉罩即刻(T6)的MAP及HR,記錄患者插管后、翻身側(cè)臥位后、手術(shù)30 min時(shí)及術(shù)畢(平臥)時(shí)的Sp O2、Pet CO2和氣道峰壓(Ppeak)。結(jié)果 L組喉罩置入一次成功率100%,停藥后清醒時(shí)間較T組縮短,差異有統(tǒng)計(jì)學(xué)意義(P0.01);喉罩拔出時(shí)間較T組短,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。T組拔管后舌根后墜發(fā)生增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。L組在T4時(shí)血壓回升,而T組循環(huán)抑制持續(xù)至T5以后。T2、T6時(shí),T組較L組血壓升高、心率加快,差異有統(tǒng)計(jì)學(xué)意義(P0.01);T4時(shí)T組較L組血壓降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。L組和T組分別在喉罩置入(氣管插管)后5 min內(nèi)和5~10 min較多出現(xiàn)低血壓,L組發(fā)生病例少于T組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。L組側(cè)臥位后,氣道密封壓下降(P0.01),但仍然高于術(shù)中最高通氣氣道壓(P0.01)。側(cè)臥位即時(shí)(托管后)Pet CO2升高(P0.01);但手術(shù)結(jié)束時(shí)與平臥時(shí)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論老年患者髖部手術(shù)中使用喉罩通氣全身麻醉,在體位變動(dòng)時(shí)采用短時(shí)間脫管的方法可有效防止喉罩被拖拽移位、漏氣,術(shù)中必須加強(qiáng)呼吸功能的監(jiān)測(cè);采用微泵注射結(jié)合靜脈推注的慢誘導(dǎo)模式,減少集中給藥引起的循環(huán)抑制。
[Abstract]:Objective to explore the management of respiratory and circulation during laryngeal mask ventilation under general anesthesia in elderly patients undergoing lateral supine hip surgery.Methods 52 elderly patients undergoing hip surgery were randomly assigned into group L (laryngeal mask general anesthesia) and group T (endotracheal intubation).Propofol and remifentanil were continuously injected intraoperatively, combined with sevoflurane inhalation anesthesia according to the intensity of surgical stimulation.The MAP and HRwere observed and recorded at 10 min after insertion, 1 min after intubation (laryngeal mask), 1 min after intubation (laryngeal mask), 5 min after intubation (laryngeal mask), 8 min after intubation (larynx mask), 8 min after intubation (larynx mask), 8 min after intubation (larynx mask).At 30 min and postoperatively (supine), SPO _ 2 Pet CO2 and peak airway pressure (Ppeaka) were observed after lateral supine position.Results the successful rate of laryngeal mask placement in group L was 100, the waking time after withdrawal was shorter than that in group T, the difference was statistically significant (P 0.01), the time of laryngeal mask pull-out was shorter than that in group T, and the difference was not statistically significant (P 0.05).There was a significant difference in blood pressure at T4 in P0.05U 路L group, while the blood pressure increased and heart rate increased in T group after T5. T2 + T6. The blood pressure in group T was significantly lower than that in group L at P0.01 and T4, and the blood pressure in group T was lower than that in group L.There were significant differences in the incidence of hypotension in group L and group T within 5 min after laryngeal mask placement (tracheal intubation) and 5 min after intubation. The incidence of hypotension in group L was less than that in group T, and the difference was statistically significant after lateral recumbent position in group P0.01.The airway seal pressure decreased (P 0.01), but it was still higher than the maximum airway pressure (P 0.01) during the operation.In the lateral position, Pet CO2 increased immediately, but there was no significant difference between the end of the operation and the supine position (P 0.05).Conclusion the laryngeal mask ventilation during hip operation is a general anesthesia in the elderly patients, and the short time extubation can effectively prevent the laryngeal mask from being towed and transposed. The monitoring of respiratory function must be strengthened during the operation.The slow induction mode of micropump injection combined with intravenous injection was used to reduce the circulatory inhibition caused by concentrated administration.
【作者單位】： 江蘇省昆山市中醫(yī)醫(yī)院;
【基金】：昆山市社會(huì)發(fā)展科技計(jì)劃項(xiàng)目(編號(hào):KS1440)
【分類(lèi)號(hào)】：R614.2

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本文編號(hào)：1768380