喉面罩对老年高血压患者腹腔镜手术应激反应影响.docVIP

喉面罩对老年高血压患者腹腔镜手术应激反应影响 　 作者：周文涛，张震波，张尚民，丁辉，王芳茹，李永宏，邓博 【摘要】 目的：比较麻醉喉面罩与气管插管对老年高血压患者腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）围术期应激反应的影响。方法：择期老年高血压患者行LC 60例，ASAⅠ～Ⅱ级，随机分成喉面罩组（A组）和导管组（B组），通气设置：潮气量(VT) 6～8 ml/kg,频率16～18/min，间歇正压通气(IPPV)，呼吸末正压3cm H2O，CO2气腹(压力lt;12mm Hg)，保持PETCO2 18～22.5mm Hg。记录两组在麻醉诱导前、插管后5min、气腹后、拔管前、拔管后5min 5个时点的心率（HR），心率与收缩压乘积(RPP)，血糖，皮质醇拔管时呛咳发生率等指标。结果：气腹对两组循环有明显的增强作用，心率与收缩压乘积较气腹前明显升高（Plt;0.05）。两组血糖自插管后均不同程度的上升，B组于插管后上升更明显，与A组比较差异有统计学意义（Plt;0.05）；两组术毕时皮质醇水平均明显上升（Plt;0.05 )，B组拔管后继续上升；A组拔管时呛咳发生率低。结论：老年高血压患者使用喉面罩，在12mm Hg CO2气腹压力下，不会影响肺通气效果，应激反应轻，心肌耗氧少，血液动力学稳定，术毕对喉面罩反应轻，耐受时间延长有利于辅助通气，拔管后通气改善更好。但应尽量减少气腹压力，气腹后、间歇正压通气期间应设一定呼吸末正压，可适当增加呼吸频率，避免发生高CO2血症。 【关键词】 喉面罩；麻醉，静脉；老年人；高血压；应激 【Abstract】 Ｏbjective:To evaluate the effect of laryngeal mask on stress reaction of the aged patients with hypertension during the laparoscopic cholecystectomy.Methods:Sixty aged patients,with ASA gradeⅠⅡ,were randomly divided into two groups,the laryngeal mask group and ductus group.Venting was set up as follows:tidal volume (VT) was 68ml/kg,frequency was 18 times/min,and PET CO2 was kept between 3.0 and 4.0 kPa.Intermittent positive pressure ventilation (IPPV) was performed and the pressure of CO2 pneumoperitoneum was less than 12mm Hg.Datas of heart rate (HR),ratepressure product (RPP)，serum glucose and hydrocortisone were recorded at five different stages,before anaesthesia,5 minutes after intubation,after CO2 pneumopeitoneum is performed before extubation,5 minutes after extubation.Results:Pneumoperitoneum enhanced circulation of the two groups obviously.HR and RPP heightened significantly when the pneumoperitoneum was performed (Plt;0.05).RPP and HR of the laryngeal mask group before extubation had no significant differences and they step up obviously in the ductus group (Plt;0.05).Serum glucose of the two groups raised at different levels after intubation.The ductus group rose significantly (Plt;0.05).Hydrocortisone of the two groups at the end of operation increased and had