喉罩通气全麻在老年患者膀胱肿瘤电切术中应用.docVIP

喉罩通气全麻在老年患者膀胱肿瘤电切术中应用 　　作者简介:盛颖,女,1978年11月,汉族,大学本科,主治医师,研究方向:临床麻醉。 　　【摘要】目的:探讨喉罩通气全麻用于膀胱肿瘤电切术对老年患者血流动力学及闭孔神经反射的影响。方法:选择行膀胱肿瘤电切术老年患者60例,ASAII级或III级,随机分为两组,A组:腰麻组,30例;B组:喉罩全麻组,30例。分别于麻醉前、麻醉后、术中、术后记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),记录术中发生闭孔神经反射情况。结果:B组SBP、DBP和HR波动比A组小,差异有统计学意义(P0.05)。B组无闭孔神经反射发生,明显好于A组26.7%的发生率。结论:在膀胱肿瘤电切术的麻醉中,喉罩通气全麻对老年患者血流动力学干扰小,术中闭孔神经反射发生率低,是膀胱肿瘤电切术较适宜的麻醉方法。? 　　【关键词】喉罩;膀胱肿瘤电切术;闭孔神经反射? 　　doi:10.3969/j.issn.1006-1959.2010.08.080文章编号:1006-1959(2010)-08-2060-02? 　　 　　【Abstract】Objective:To investigate the influence of total intravenous anesthesia with laryngeal mask airway on hemodynamics and obturator nerve reflex in old patients undergoing transurethral resection of bladder tumor.Methods:Sixty ASA II or III old patients undergoing transurethral resection of bladder tumor were randomly divided into two groups.Group A:laryngeal mask airway,n=30;group B:spinal anesthesia,n=30.SBP,DBP,MAP,HR and pertinent side-effects were monitored and recorded.Results:The homodynamic in group B experienced more stable than those in group A.Obturator nerve reflex was observed in 8 patients in group A,but none in group B.Conclusion:Total intravenous anesthesia with laryngeal mask airway has small interference on homodynamic in old patients undergoing transurethral resection of bladder tumor,and eliminate obturator nerve reflex.? 　　【Key words】Laryngeal mask airway;Transurethral resection of bladder tumor;Obturator nerve reflex 　　 　　老年患者行膀胱肿瘤电切术多采用椎管内麻醉,但老年患者腰麻后低血压等的发生率较高,且不能有效抑制闭孔神经反射。本研究拟探讨喉罩通气全麻用于老年患者膀胱肿瘤电切术的安全性、有效性,为此类手术的临床麻醉提供参考。? 　　 　　1.资料与方法? 　　 　　1.1一般资料:择期行膀胱肿瘤电切术老年患者60例,年龄65~90岁,体重44~76kg,男性48例,女性12例,ASAII或III级。肿瘤均位于膀胱侧壁,手术时间20~88min。将患者随机分为两组,A组:腰麻组,30例;B组:喉罩全麻组,30例。各组患者在性别、年龄、体重、手术时间上差异无统计学意义(P0.05)。? 　　1.2方法:所有患者未用术前药,入室后监测血压、心电图、心率和脉搏血氧饱和度,喉罩组监测呼吸末二氧化碳。A组于L3,4间隙穿刺,蛛网膜下腔注入0.75%布比卡因1~1.2ml,控制腰麻阻滞平面在T6以下;B组,静脉注射异丙酚1.5~2mg/kg、芬太尼3μg/kg、罗库溴铵0.3mg/kg麻醉诱导。根据体重选择3~4号喉罩,置入喉罩后用听诊法确定位置,明确无漏气和梗阻后连接麻醉机。术中以瑞芬太尼以0.2μg//kg?min,异丙酚5~10mg/kg?h持续微泵注射维持麻醉,必要时追加罗库