CAJ | 학술논문

目的比较患者耐受喉罩或气管导管时七氟烷的麻醉深度.方法择期拟行甲状腺手术和乳腺手术的全麻患者80例,ASA Ⅰ或Ⅱ级,年龄30～60岁,体重50～70kg,随机分为2组(n=40):喉罩组(LMA组)和气管导管组(TT组).麻醉诱导:两组均静脉注射异丙酚1.6mg/kg、芬太尼3μg/kg和罗库溴铵0.6mg/kg,插入喉罩或气管导管,行机械通气.麻醉维持:LMA组吸入1.5%～3.0%七氟烷和50%氧化亚氮,TT组吸入2.5%～5.0%七氟烷和50%氧化亚氮.氧气和氧化亚氮的流量均为0.7～1.0 L/min,调节七氟烷吸入浓度,维持听觉诱发电位指数(AAI)15～25.于喉罩或气管导管置入后1min(T1)、5 min(T2)、10 min(T3)、切皮后1h(T4)、术毕拔除喉罩或气管导管前即刻(T5)时记录七氟烷呼气末浓度.记录苏醒时间、心血管不良事件和不良反应的发生情况.结果与TT组比较,LMA组七氟烷呼气末浓度降低,苏醒时间和拔除喉罩或气管导管的时间缩短,心动过速、苏醒期躁动、咽痛、头晕嗜睡和寒战的发生率降低(P<0.05).结论在相同的麻醉深度(AAI 15～25)下,患者耐受喉罩比耐受气管导管的七氟烷呼气末浓度降低,并发症少,心血管反应小.
목적 비교환자내수후조혹기관도관시칠불완적마취심도.방법 택기의행갑상선수술화유선수술적전마환자80례,ASA Ⅰ혹Ⅱ급,년령30～60세,체중50～70kg,수궤분위2조(n=40):후조조(LMA조)화기관도관조(TT조).마취유도:량조균정맥주사이병분1.6mg/kg、분태니3μg/kg화라고추안0.6mg/kg,삽입후조혹기관도관,행궤계통기.마취유지:LMA조흡입1.5%～3.0%칠불완화50%양화아담,TT조흡입2.5%～5.0%칠불완화50%양화아담.양기화양화아담적류량균위0.7～1.0 L/min,조절칠불완흡입농도,유지은각유발전위지수(AAI)15～25.우후조혹기관도관치입후1min(T1)、5 min(T2)、10 min(T3)、절피후1h(T4)、술필발제후조혹기관도관전즉각(T5)시기록칠불완호기말농도.기록소성시간、심혈관불량사건화불량반응적발생정황.결과 여TT조비교,LMA조칠불완호기말농도강저,소성시간화발제후조혹기관도관적시간축단,심동과속、소성기조동、인통、두훈기수화한전적발생솔강저(P<0.05).결론 재상동적마취심도(AAI 15～25)하,환자내수후조비내수기관도관적칠불완호기말농도강저,병발증소,심혈관반응소.
Objective To compare the effects of patient's tolerance to laryngeal mask airway (LMA) and tracheal tube (TT) on the appropriate level of sevoflurane anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 30-60 yr weighing 50-70 kg undergoing elective thyroid or breast surgery were randomly divided into 2 groups (n=40 each):LMA group and TT group.Anesthesia wag induced with propofol 1.6mg/kg,fentanyl 3μg/kg and recuronium 0.6mg/kg.LMA or tracheal tube was inserted,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of 1.5%-3.0% sevoflurane and 50% N2O in O2 in group LMA,and with 2.5%-5.0% sevoflurane and 50% N2O in O2 in group TT.The flow of O2 and N2O was 0.7-1.0L/min,and the concentration of sevofluranee was adjusted to maintain AAI at 15-25.ECG,HR,MAP,SpO2,PETCO2,AEP and end-tidal sevoflurane concentration were continuonsly monitored.The end-tidal sevoflurane concentration was recorded at 1,5 and 10 min after LMA/TT was placed (T1-3),at 1h after skin incision (T4) and at the end of operation before removal of LMA or extubation (T5).The recovery time of consciousness,adverse cardiovascular events and adverse reactions were recorded.Results The end-tidal sevoflurane concentration was significantly lower,the recovery time of consciousness and removal of LMA or extubation time were shorter,and the incidence of adverse cardiovascular events and adverse reactions was lower in LMA group than in TT group.Conclusion At the same depth of anesthesia (AAI 15-25),sevoflurane concentration is significantly lower in LMA group than in TT group,with fewer complications and smaller cardiovascular reaction.