喉罩保留自主呼吸在全身麻醉中的应用.docVIP

喉罩保留自主呼吸在全身麻醉中的应用 姚 新 梅 摘要：目的：观察喉罩（LMA）保留自主呼吸在麻醉中的应用。方法：选择ASAＩ～ＩＶ级, 行全麻喉罩插管的择期手术病人80例。麻醉诱导静脉用芬太尼1-2ug/kg, 异丙酚2-3mg/kg，吸入七氟醚和笑气。维持用芬太尼、笑气(50%)、七氟醚和氧气。所有病人术中保留自主呼吸。观察诱导前和置喉罩后不同时间点血流动力学、血氧饱和度（SpO2）））））） Clinical applicationt of laryngeal mask airway during general anesthesia with spontaneous breathing Abstract: Objective: To observe the application of laryngeal mask airway during general with spontaneous breathing. Methods: 80 ASA physical status Ⅰ-Ⅳ patients scheduled to undergo general anesthesia for operations with LMA in which neuromuscular relaxation is undesirable. Fentanyl/Propofol and N2O in O2 with sevoflurane were used to induce anesthesia. General anesthesia was maintained with fentanyl, nitrous oxide (50%), sevoflurane and oxygen. Patients breathed spontaneously during the operation. HR, SP/DP, SpO2, PETCO2 before induction and different time after LMA were observed. Results: HR, SP/DP were decreased after LMA and 10min, 20min after LMA, compared with before induction (P0.05). But they were still in normal range. Moreover, haemodynamic parameters keep stable after LMA. SpO2 was greater after LMA than before induction. PETCO2 was normal and keep stable during the spontaneous breathing. Conclusions: Laryngeal mask airway during general anesthesia with spontaneous breathing has the advantages as follows: haemodynamic is stable, no hypoxia and hypercapnia. Don’t need to worry about the extubation after operation. Key words: Largngeal mask airway; spontaneous breathing; general aneathesia. 喉罩通气道(Laryngeal Mask Airway, LMA)是近年来用于临床的新型气道维持方式。具有操作简单, 创伤小及良好的声带保护作用。在临床上得到了广泛的应用。国内，喉罩在术中的应用大部分都是用肌松药行控制呼吸（IPPV）,。 然而, LMA不足之处在于密封效果不好，胃胀气发生率高，应用LMA时行IPPV患者更易于胃胀且己有肺误吸的报道,。而且，已有研究表明,保留自主呼吸有助于血流动力学的稳定、改善通气/血流比例失调、减少肺不张的形成及有利于早期拔管。现将本人应用喉罩保留自主呼吸的体会报告如下。 1 资料与方法 1.1 临床资料 本组患者80例, 男48 例, 女32例, 年龄20～89岁, 体重52～105kg。 ASA分级Ｉ～ＩＶ级。泌尿外科的膀胱镜检, 输尿管插管及碎石32例; A-V造瘘6例; 骨科的上下肢手术18例 (其中上肢外伤缝合8例, 关节腔检查镜10例); 皮肤癌肿瘤切除12例；妇产科的宫腔镜人流手术12例。 1.2 方法 1.2.1麻醉方法 手术未用术前药。诱导静脉用芬太尼1-2ug/kg, 异丙酚