喉罩保留自主呼吸在全身麻醉中应用.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）及呼末二氧化碳（PETCO2）的变化。 结果：置入喉罩后不同观察时间段心率（HR）、血压（SP/DP）比诱导前降低，有统计学差异（P0.05）；但均在正常范围之内。置入喉罩后不同时间点之间无显著性差异。SpO2比诱导时提高，且有统计学差异（P0.05）。PETCO2术中保持在正常范围之内，并无增加趋势。结论：应用LMA保留自主呼吸，具有术中血流动力学稳定，未出现缺氧及二氧化碳蓄积，也无反流误吸的发生，不用担心术后拔管等优点. 关键词：喉罩; 自主呼吸; 全身麻醉. 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） 张玉良　都大伟　岳　云等. 120例喉罩通气腹腔镜胆囊切除术麻醉报告. 张玉良　都大伟　岳　云等. 120例喉罩通气腹腔镜胆囊切除术麻醉报告. 中华外科杂志1997; 35 (12): 769 云虹, 钱朝霞. 喉罩在乳癌麻醉中的应用. 中国肿