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1、喉罩通气在甲状腺手术全身麻醉中应用【摘要】目的观察甲状腺手术中应用喉罩通气行全身麻醉对血流动力学的影响。方法50例甲状腺手术的择期手术患者,随机分成气管插管组(T组)和喉罩置入组(L组),每组25例,气管插管用喉镜明视插入法,喉罩置入按顺行盲探置入口底。记录麻醉诱导前(T0)、诱导后(T1)气管插管后1min(T2)、3min(T3)、拔除气管导管或喉罩后1min(T4)各时间点的SBP、DBP、HR值,术后3d随访患者咽痛、声音嘶哑的发生率。结果T组在插管后1min(T2)、3min(T3)、拔管后1min(T4)SBP、DBP、HR较诱导前明显升高(P<0.05),而
2、L组在T2、T3、T4点SBP、DBP、HR与T0相比,无明显差异(P>0.05);组间比较,T组在T2、T3、T4点的SBP、DBP、HR明显高于L组(P<0.05)。术后L组咽痛、声音嘶哑发生例数少于T组(P<0.05)。结论喉罩通气全身麻醉对血流动力学影响小,不良反应小,适合于甲状腺手术全麻的要求。【关键词】喉罩通气;全身麻醉;甲状腺切除术ApplicationofLaryngealMask-airwayinGeneralAnesthesiaforThyroidectomyPatientsCHENXiao-yan,HANWei.DepartmentofAnesthe
3、siology,People’sHospitalof7JiXi,Heilongjiang158100,China【Abstract】ObjectiveTostudytheeffectoflaryngealmaskairway(LMA)forhemodynamicchangesingeneralanesthesiaforthyroidectomypatients.Methods50patientswhoundermentthyroidectomywererandomlydividedinto2groupswith25caseseach,includinggroupTwith
4、trachealintubationbylaryoscopyandgroupLwithblindantegradeLMAinsertiontomouthfloor.ThevalueofSBP、DBPandHRweremeasuredatthetimebeforetrchealintubationorLMAinsertion(T0),andafterintubationorLMAplacing1minutes(T2),3minutes(T3),afterextubateintubationorLMA1minutes(T4).Andmorbidityrateofside-in
5、jurysuchaspharyngodyandhoarsenesswererecordedduring3daysafteroperation.ResultsTherewasnoobvioushemodynamicchangeatT2~T4amonythegroupL(P>0.05),whiletheSBP、DBPandHRatT2~T4weresignificantlyhigherthanthoseofT0ingroupT(P<0.05).ComparingwithgroupL,thevalueofSBP、DBPandHRwereremarkablehigheringro
6、upTatT2~T4.Themorbidityrateofpharyngodyniaandhoarsenessafteroperationwas7obviouslyhigheringroupTthanthatofgroupL(P<0.05).ConclusionLMAwassuitableforthyroidectomyoperationwithlesshemodynamicchanges,highersafetyandlessside-effect.【Keywords】Laryngealmask;Generalanesthesia;Thyroidectomy喉罩是集面罩
7、和气管内插管优点于一体的维持气道的新型麻醉器具,喉罩在维持呼吸道通畅时不仅可以保持自主呼吸,也可以进行辅助和控制呼吸。由于放置喉罩对患者咽喉刺激相对较小,心血管反应轻,可以快速建立有效通气,其应用已越来越广泛。作者采用喉罩通气全麻应用于甲状腺手术,效果满意。现报告如下。1临床资料1.1一般资料选择拟行甲状腺手术的择期患者50例,ASA分级Ⅰ~Ⅱ级,其中男10例,女30例,年龄19~55岁,体质量45~68kg,基础代谢率及T3、T4指标均在正常范围。其中行一侧腺叶切除术12例,一侧腺叶切除联合对侧腺叶结节摘除术25例,双侧腺叶