本文選題：i-gel喉罩 + 氣管插管　； 參考：《山東大學(xué)》2016年碩士論文

【摘要】：目的：探討i-gel聯(lián)合氣管導(dǎo)管全身麻醉在老年患者俯臥位胸腰椎手術(shù)中應(yīng)用的臨床效果及安全性。方法：選取60例年齡≥65歲,骨科行俯臥位胸腰椎擇期手術(shù)的患者,隨機(jī)編入i-gel聯(lián)合氣管導(dǎo)管組(IT組)和單純氣管導(dǎo)管組(T組)。IT組和T組均常規(guī)準(zhǔn)備,留置外周靜脈通路后推入手術(shù)室,并實(shí)時(shí)監(jiān)測(cè)心率、血壓及脈搏氧飽和度。兩組患者均先后靜脈推注咪達(dá)唑侖0.05 mg/kg.依托咪酯0.2 mg/kg.舒芬太尼0.5 ug/kg、羅庫溴銨1 mg/kg,行快速靜脈誘導(dǎo),輔助呼吸5 min后,IT組置入i-gel喉罩,置入成功后以膠帶固定,連接麻醉機(jī)機(jī)械通氣,選擇通氣模式為容量控制,設(shè)置潮氣量8 ml/kg,通氣頻率12次/min,吸呼比1：1.5,氧流量2 L/min。機(jī)械通氣5 min后,經(jīng)i-gel喉罩置入氣管導(dǎo)管,充起氣囊,兩肺聽診呼吸音對(duì)稱,以膠帶將氣管導(dǎo)管與i-gel喉罩固定為一體,氣管導(dǎo)管一端連接麻醉機(jī),以原通氣模式通氣。T組采用喉鏡暴露聲門,置入加強(qiáng)型氣管導(dǎo)管,連接麻醉機(jī)機(jī)械通氣,通氣模式同IT組。麻醉維持：持續(xù)靜脈輸注丙泊酚4.5 mg/kg/h.瑞芬太尼10 ug/kg/h,吸入七氟烷0.8～1.0 MAC,術(shù)中調(diào)節(jié)麻醉維持藥物的輸注速度,維持BIS值在40-60之間。間斷靜脈推注順式阿曲庫銨0.1 mg/kg直至手術(shù)結(jié)束前1 h,以維持患者肌松, 維持患者生命體征平穩(wěn)。兩組患者均在俯臥位下行手術(shù),術(shù)畢前,待患者恢復(fù)仰臥位后,停止泵注丙泊酚及瑞芬太尼,IT組在麻醉狀態(tài)下吸痰拔出氣管導(dǎo)管,以i-gel喉罩維持通氣；T組繼續(xù)以氣管導(dǎo)管維持通氣。待患者意識(shí)清醒、自主呼吸恢復(fù)、肌力恢復(fù)、脫氧5 minSpO2能維持在95%以上時(shí)拔出i-gel喉罩／氣管導(dǎo)管。觀察并且記錄兩組患者的年齡、性別、體重、身高、ASA分級(jí)、手術(shù)時(shí)間、麻醉及蘇醒時(shí)間；分別在麻醉誘導(dǎo)前(TO)、誘導(dǎo)結(jié)束置入氣管導(dǎo)管即刻(T1)手術(shù)結(jié)束拔出i-gel喉罩或氣管導(dǎo)管即刻(T2)、拔出i-gel喉罩或氣管導(dǎo)管后5min(T3)時(shí)記錄兩組患者的MAP、HR、SpO2;抽取靜脈血測(cè)定兩組患者T0-T3各時(shí)點(diǎn)的血糖及血漿皮質(zhì)醇濃度水平；記錄平臥位兩組患者置入氣管導(dǎo)管后5min(T4)、俯臥位手術(shù)開始后30min(T5)及術(shù)畢即刻俯臥位時(shí)(T6)的Ppeak. PETCO2。結(jié)果：兩組患者一般情況、麻醉時(shí)間、手術(shù)及拔管時(shí)間差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。與TO相比,T組患者T1、T2、T3各時(shí)點(diǎn)MAP、HR均明顯升高(P0.05)；IT組患者則無明顯變化(P0.05)。與T組相比,IT組患者T1、T2、T3各時(shí)點(diǎn)MAP、HR明顯降低(P0.05)。與TO相比,兩組患者T1、T2、T3各時(shí)點(diǎn)血糖及血漿皮質(zhì)醇水平均明顯升高(P0.05)；與T組相比,IT組患者T1、T2、T3各時(shí)點(diǎn)血糖及血漿皮質(zhì)醇水平均顯著降低(P0.05)。與T組相比,IT組患者T4、T5、T6各時(shí)點(diǎn)Ppeak明顯升高(P0.01),但通過適當(dāng)調(diào)快呼吸頻率,所有患者的Ppeak都不高于25cmH2O此外,通過適當(dāng)調(diào)快呼吸頻率,減少潮氣量,兩組患者的PETCO2均控制在35～45mmHg之間,結(jié)果無明顯差異(P〉0.05)。結(jié)論：老年患者俯臥位胸腰椎手術(shù)使用i-gel喉罩聯(lián)合氣管導(dǎo)管全身麻醉,氣道穩(wěn)定性和通氣安全性和單純氣管插管相似,但患者圍麻醉期的血流動(dòng)力學(xué)更加穩(wěn)定,應(yīng)激反應(yīng)程度也大大降低,術(shù)后麻醉蘇醒質(zhì)量高,安全性及可控性好。
[Abstract]:Objective: To investigate the clinical effect and safety of I-gel combined with tracheal tube general anesthesia in the prone position of thoracic and lumbar vertebrae in elderly patients. Methods: 60 patients aged 65 years old and 65 years old, the patients in the prone position of thoracic and lumbar elective surgery were randomly assigned to I-gel combined tracheal catheter group (group IT) and simple tracheal catheter group (group T).IT and T group. The two groups of patients were given intravenous injection of midazolam 0.05 mg/kg. etomidate 0.2 mg/kg. sufentanil 0.5 ug/kg and rocuronium 1 mg/kg, and the IT group was placed in the I-gel laryngeal mask after 5 min assisted respiration. After success, it was fixed with adhesive tape, mechanical ventilation with anesthesia machine, ventilation mode for capacity control, setting moisture volume 8 ml/kg, ventilation frequency 12 times /min, suction ratio 1:1.5, oxygen flow 2 L/min. mechanical ventilation 5 min, I-gel laryngeal mask airway catheter, filling air bag, two lung auscultation breathing sound symmetry, duct duct and I-gel larynx with adhesive tape One end of the mask was connected with the anesthesia machine, and the.T group was ventilated by the original ventilation mode to expose the glottis with laryngoscope, put into the reinforced tracheal tube, connect the mechanical ventilation with the anesthesia machine, the ventilation mode and the IT group. The anesthesia was maintained: continuous intravenous infusion of propofol 4.5 mg/kg/h. renfentanyl 10 ug/kg/h, inhaled seven fluorane 0.8 ~ 1 MAC, intraoperative regulation The anesthesia maintained the infusion speed of the drug, maintaining the value of BIS between 40-60. Intermittent intravenous infusion of CIS atracurium 0.1 mg/kg until 1 h before the end of the operation, to maintain the patient's muscle relaxation and maintain the patient's vital signs. The two groups were operated in the prone position, and the patient was restored to the supine position before the patient was restored to the supine position and stopped pumping propofol and remifentin In group IT, the tracheal tube was drawn out in the anesthetized state, and the ventilation was maintained with the I-gel laryngeal mask, and the T Group continued to maintain ventilation with the tracheal catheter. The patients were awake, self breathing recovery, the muscle strength recovery, and the deoxygenation 5 minSpO2 could be pulled out of the I-gel laryngeal mask / tracheal catheter. The age, sex, weight of the two groups of patients were observed and recorded. Height, ASA classification, operation time, anesthesia and awakening time, respectively, before induction of anesthesia (TO), the end of the induction endotracheal catheter at the end of the induction (T1) to pull out the I-gel laryngeal mask or the tracheal catheter immediately (T2), the I-gel laryngeal mask or the tracheal catheter after 5min (T3) recorded the two groups of MAP, HR, SpO2; extraction of venous blood of two groups of patients T0-T3 each Blood glucose and plasma cortisol concentration at the time point; recorded the 5min (T4) of the two groups of patients in the supine position, 30min (T5) after the prone position and the Ppeak. PETCO2. in the immediate prone position (T6): the general situation, the time of anesthesia, the difference of hand and extubation time were not statistically significant (P0.05) in the two groups (P0.05). In group T, T1, T2, and T3 were significantly higher in MAP and HR at each time point (P0.05), and there was no significant change in IT group (P0.05). Compared with the T group, IT group was significantly lower. Time point blood glucose and plasma cortisol level were significantly decreased (P0.05). Compared with group T, the Ppeak of T4, T5, T6 at each time point in group IT was significantly increased (P0.01), but the Ppeak of all patients was not higher than 25cmH2O by appropriate rapid respiration rate, and the volume of moisture was reduced by the appropriate rate of respiratory frequency, and the PETCO2 of the two groups was controlled in 35 ~ 45mmHg. There was no significant difference between the results (P 0.05). Conclusion: the elderly patients with the prone position of the thoracic and lumbar spine were treated with the I-gel laryngeal mask combined with tracheal catheter general anesthesia, the airway stability and ventilation safety were similar to the simple tracheal intubation, but the hemodynamics of the patients during the perioperative period were more stable, the degree of stress reaction was greatly reduced, and the postoperative anesthesia revived. High quality, good safety and good controllability.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R614.2

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