喉罩與氣管插管用于甲狀腺瘤全麻手術(shù)的比較研究
發(fā)布時間：2018-08-21 09:46
【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用于甲狀腺瘤切除術(shù)中血流動力學變化及應激反應,為臨床麻醉提供參考。 方法： 延邊大學附屬醫(yī)院選取甲狀腺瘤病人40例,ASA分級Ⅰ～Ⅱ級。術(shù)前檢查病人無循環(huán)及呼系系統(tǒng)疾患,無竇性心動過緩和高血壓,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因素,無通氣困難等喉罩應用禁忌癥。手術(shù)時間35-45分鐘�；颊唠S機分為喉罩全麻組(L組,20例)和喉鏡引導下氣管插管組(T組,20例)。全麻誘導咪唑安定0.05mg/kg,依托咪酯0.3mg/kg,注射用順苯磺酸阿曲庫銨0.2mg/kg,枸櫞酸芬太尼0.1mg,靜脈誘導3min后,插入氣管導管或喉罩,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小時麻醉相關(guān)并發(fā)癥及處理措施,統(tǒng)計兩組患者蘇醒時間,定向力恢復時間,拔管時間和麻醉費用情況。 結(jié)果： ①喉罩置入時間平均值小于氣管插管時間。氣管插管組2例插管困難,經(jīng)反復操作后成功。②喉罩組在T2、T4時的收縮壓(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間,定向力恢復時間,拔管時間及麻醉費用方面差異無統(tǒng)計學意義(P0.05)。 結(jié)論： 全麻喉罩通氣可以很好地應用于甲狀腺瘤全麻手術(shù)患者,且優(yōu)于氣管內(nèi)插管,易于維持血流動力學穩(wěn)定,麻醉不良反應少,全麻后恢復平穩(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.
【學位授予單位】：延邊大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R736.1
本文編號：2195323
[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.
【學位授予單位】：延邊大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R736.1
【參考文獻】
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;2011年05期
2 楊志偉;吳達豐;;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用[J];臨床麻醉學雜志;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)高專學報;2012年06期
5 朱小勇;徐榮鋼;陸文英;;喉罩通氣復合頸叢阻滯麻醉在甲狀腺手術(shù)中的應用[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2007年14期
6 馬長青;鄧乃封;;喉罩臨床應用的進展[J];醫(yī)學綜述;2006年19期
7 王勇;馬武華;;喉罩在小兒麻醉復蘇中的應用進展[J];醫(yī)學綜述;2009年17期
8 黃春蘋;;喉罩的臨床應用進展(綜述)[J];中國城鄉(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;;插管型喉罩引導下氣管插管在困難氣道管理中的應用[J];中國現(xiàn)代醫(yī)生;2007年22期
10 項雪琴;喉罩通氣道在老年全身麻醉中的應用[J];中國基層醫(yī)藥;2005年10期
，本文編號：2195323
本文鏈接：http://sikaile.net/yixuelunwen/mazuiyixuelunwen/2195323.html
最近更新
教材專著
