【摘要】：目的： 探討喉罩用于甲狀腺瘤全麻手術(shù)的安全性及可行性,比較喉罩置入和氣管插管下全身麻醉應(yīng)用于甲狀腺瘤切除術(shù)中血流動(dòng)力學(xué)變化及應(yīng)激反應(yīng),為臨床麻醉提供參考。 方法： 延邊大學(xué)附屬醫(yī)院選取甲狀腺瘤病人40例,ASA分級(jí)Ⅰ～Ⅱ級(jí)。術(shù)前檢查病人無循環(huán)及呼系系統(tǒng)疾患,無竇性心動(dòng)過緩和高血壓,均未發(fā)現(xiàn)肝,腎及內(nèi)分泌等系統(tǒng)疾病,無張口困難和增加反流誤吸危險(xiǎn)因素,無通氣困難等喉罩應(yīng)用禁忌癥。手術(shù)時(shí)間35-45分鐘�；颊唠S機(jī)分為喉罩全麻組(L組,20例)和喉鏡引導(dǎo)下氣管插管組(T組,20例)。全麻誘導(dǎo)咪唑安定0.05mg/kg,依托咪酯0.3mg/kg,注射用順苯磺酸阿曲庫(kù)銨0.2mg/kg,枸櫞酸芬太尼0.1mg,靜脈誘導(dǎo)3min后,插入氣管導(dǎo)管或喉罩,記錄兩組患者心率(HR),收縮壓(SBP),舒張壓(DBP)和平均動(dòng)脈壓(MAP),并記錄兩組患者置入期,手術(shù)中,拔管期,術(shù)后24小時(shí)麻醉相關(guān)并發(fā)癥及處理措施,統(tǒng)計(jì)兩組患者蘇醒時(shí)間,定向力恢復(fù)時(shí)間,拔管時(shí)間和麻醉費(fèi)用情況。 結(jié)果： ①喉罩置入時(shí)間平均值小于氣管插管時(shí)間。氣管插管組2例插管困難,經(jīng)反復(fù)操作后成功。②喉罩組在T2、T4時(shí)的收縮壓(SBP)、舒張壓(DBP)、心率(HR)與To相比變化不大(P0.05)；氣管插管組在T2、T4時(shí)的SBP, DBP和HR明顯高于To(P0.05)；喉罩組與氣管插管比較發(fā)現(xiàn),喉罩組在T2-T5時(shí)的SBP、DBP和HR均明顯低于氣管插管組(P0.05)。③麻醉相關(guān)并發(fā)癥。術(shù)后,氣管插管組有3例咽痛,喉罩置入組無。④兩組患者在蘇醒時(shí)間,定向力恢復(fù)時(shí)間,拔管時(shí)間及麻醉費(fèi)用方面差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論： 全麻喉罩通氣可以很好地應(yīng)用于甲狀腺瘤全麻手術(shù)患者,且優(yōu)于氣管內(nèi)插管,易于維持血流動(dòng)力學(xué)穩(wěn)定,麻醉不良反應(yīng)少,全麻后恢復(fù)平穩(wěn)。
[Abstract]:Objective: to investigate the safety and feasibility of laryngeal mask in general anesthesia for thyroidoma, and to compare the hemodynamic changes and stress response between laryngeal mask placement and general anesthesia under tracheal intubation in thyroidectomy. To provide reference for clinical anesthesia. Methods: 40 patients with thyroid tumor were selected from affiliated Hospital of Yanbian University. There were no circulatory and respiratory system diseases, no sinus tachycardia and hypertension, no systemic diseases such as liver, kidney and endocrine, no difficulty in opening mouth and increasing risk factors of reflux missuction, no contraindication in laryngeal mask application. The operative time was 35-45 minutes. Patients were randomly divided into laryngeal mask general anesthesia group (group L, n = 20) and laryngoscopic tracheal intubation group (group T, n = 20). General anesthesia induced midazolam 0.05 mg / kg, etomidate 0.3 mg / kg, cisbenzenesulfonic acid 0.2 mg / kg, fentanyl citrate 0.1 mg / kg. After intravenous induction of 3min, tracheal catheter or laryngeal mask was inserted. Heart rate (HR), systolic blood pressure (HR), (SBP), diastolic pressure (DBP) and mean arterial pressure (MAP),) were recorded in both groups. The duration of implantation, operation, extubation, anaesthesia related complications and management were recorded. Orientation recovery time, extubation time and anaesthesia cost. Results: 1 the mean time of laryngeal mask placement was less than that of tracheal intubation. Two cases of tracheal intubation group were difficult to intubate, and the systolic pressure (SBP), diastolic pressure (DBP), heart rate (HR) of the laryngeal mask group at T _ 2 T _ 4 were not significantly different from that of to (P0.05), SBP, DBP and HR of tracheal intubation group at T _ 2 T _ 4 were significantly higher than to (P 0.05). Compared with tracheal intubation in laryngeal mask group, SBP DBP and HR in laryngeal mask group were significantly lower than those in tracheal intubation group (P0.05). There were no significant differences in recovery time, recovery time of directional force, extubation time and anaesthesia cost between the two groups in tracheal intubation group (3 cases), laryngeal mask group (4. 4) (P0.05). Conclusion: laryngeal mask ventilation under general anesthesia can be used well in patients with thyroid tumor undergoing general anesthesia, and is superior to endotracheal intubation. It is easy to maintain hemodynamic stability, has fewer adverse reactions, and recovers smoothly after general anesthesia.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R736.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李滿新;;芬太尼聯(lián)合丙泊酚麻醉下兩種氣管插管的臨床效果比較[J];海峽藥學(xué);2011年05期

2 楊志偉;吳達(dá)豐;;經(jīng)喉罩全憑異氟醚吸入麻醉在小兒淺表手術(shù)中的應(yīng)用[J];江西醫(yī)藥;2007年03期

3 周仁龍;杭燕南;;第三代喉罩的臨床應(yīng)用[J];臨床麻醉學(xué)雜志;2006年11期

4 裴幼程;顏青華;;SLIPA喉罩與氣管插管用于甲狀腺手術(shù)的比較[J];景德鎮(zhèn)高專學(xué)報(bào);2012年06期

5 朱小勇;徐榮鋼;陸文英;;喉罩通氣復(fù)合頸叢阻滯麻醉在甲狀腺手術(shù)中的應(yīng)用[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2007年14期

6 馬長(zhǎng)青;鄧乃封;;喉罩臨床應(yīng)用的進(jìn)展[J];醫(yī)學(xué)綜述;2006年19期

7 王勇;馬武華;;喉罩在小兒麻醉復(fù)蘇中的應(yīng)用進(jìn)展[J];醫(yī)學(xué)綜述;2009年17期

8 黃春蘋;;喉罩的臨床應(yīng)用進(jìn)展(綜述)[J];中國(guó)城鄉(xiāng)企業(yè)衛(wèi)生;2012年03期

9 何海波;杜建龍;包梅芳;周哲峰;王琦;張芬芬;;插管型喉罩引導(dǎo)下氣管插管在困難氣道管理中的應(yīng)用[J];中國(guó)現(xiàn)代醫(yī)生;2007年22期

10 項(xiàng)雪琴;喉罩通氣道在老年全身麻醉中的應(yīng)用[J];中國(guó)基層醫(yī)藥;2005年10期

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