CAJ | 학술논문

目的研究喉罩对颈总动脉(CCA)和颈内动脉(ICA)内径、血流速率和血流量等血流动力学参数的影响.方法随机选择择期全麻下行腹腔镜胆囊切除术患者60例,为美国麻醉医师协会(ASA)Ⅰ～Ⅲ级.根据不同年龄分为中青年组(A组,20～59岁)和老年组(B组,60～85岁).按不同的喉罩套囊内压力将A组和B组分为4个亚组,即A1、B1(套囊内压为20～30 cm H2O)(1 cm H2O=0.098 kPa)和A2、B2(套囊内压为40～50 cm H2O),每组15例.所有患者术毕后送入ICU复苏,尚未清醒时拔除气管导管,而后置入喉罩.记录置入喉罩前(T0),置入喉罩后3 min(T1)、10 min(T2)和拔除喉罩后(T3)各时点CCA和ICA的内径、血流速率和血流量等血流动力学参数以及生命体征参数.结果 CCA、ICA的内径和CCA血流量的基础值B组比A组要大(P<0.05).与T0比较,在T1和T2时点,A组和B组CCA内径分别减少9.5%～12.9%和14.5%～24.3%(P<0.05或P<0.01),其中以B2组减少最为显著,A2组和B2组ICA内径分别减少10.9%和16.3%(P<0.05).CCA和ICA的血流速率无明显变化(P>0.05).与T0比较,A组和B组,T1和T2时CCA的血流量分别减少9.3%～10.7%和12.2%～19.1%(P<0.05),其中以B2组减少最为显著,A组和B组ICA血流量分别减少10.0%～13.5%和13.9%～16.6%(P<0.05).在T3时点各观察指标均恢复至T0水平.结论喉罩通气时,CCA和ICA的内径有所缩小,其血流量相应减少,老年患者减少更为明显,而其血流速率则无明显改变.
목적 연구후조대경총동맥(CCA)화경내동맥(ICA)내경、혈류속솔화혈류량등혈류동역학삼수적영향.방법 수궤선택택기전마하행복강경담낭절제술환자60례,위미국마취의사협회(ASA)Ⅰ～Ⅲ급.근거불동년령분위중청년조(A조,20～59세)화노년조(B조,60～85세).안불동적후조투낭내압력장A조화B조분위4개아조,즉A1、B1(투낭내압위20～30 cm H2O)(1 cm H2O=0.098 kPa)화A2、B2(투낭내압위40～50 cm H2O),매조15례.소유환자술필후송입ICU복소,상미청성시발제기관도관,이후치입후조.기록치입후조전(T0),치입후조후3 min(T1)、10 min(T2)화발제후조후(T3)각시점CCA화ICA적내경、혈류속솔화혈류량등혈류동역학삼수이급생명체정삼수.결과 CCA、ICA적내경화CCA혈류량적기출치B조비A조요대(P<0.05).여T0비교,재T1화T2시점,A조화B조CCA내경분별감소9.5%～12.9%화14.5%～24.3%(P<0.05혹P<0.01),기중이B2조감소최위현저,A2조화B2조ICA내경분별감소10.9%화16.3%(P<0.05).CCA화ICA적혈류속솔무명현변화(P>0.05).여T0비교,A조화B조,T1화T2시CCA적혈류량분별감소9.3%～10.7%화12.2%～19.1%(P<0.05),기중이B2조감소최위현저,A조화B조ICA혈류량분별감소10.0%～13.5%화13.9%～16.6%(P<0.05).재T3시점각관찰지표균회복지T0수평.결론 후조통기시,CCA화ICA적내경유소축소,기혈류량상응감소,노년환자감소경위명현,이기혈류속솔칙무명현개변.
Objective To study the effects of laryngeal mask airway (LMA) on the hcmadynamics such as inner diameter , blood flow rate and volume of blood flow, etc of common carotid artery (CCA) and internal carotid artery(ICA) . Methods Sixty patients,aged 20-85y, weight 50-75 kg,with ASA grade Ⅰ-Ⅲ, undergone selective operation of laparoscopic cholecystectomy, were randomly allocated into two groups according to age: group A(20-59 y) and group B(60-85 y). Group A and group B were divided into A1 and B1 (cuff pressure: 20-30 cm H2O) (1 cm H20=0.098 kPa), A2 and B2 (cuff pressure: 40-50 cm H2O) respectively according to cuff pressure of 15 patients each. All the patients were given tracheal intubation and general anesthesia in operation. After the operation, patients were resuscitated in the Intensive Care Unit. Then the endotraeheal catheter was pulled out and LMA was inserted. Hemodynamics such as inner diameter, blood flow rate and volume of blood flow, ere of CCA and ICA , and vital sign were recorded before LMA insertion(T0) and at 3 min(T1), 10 min(T1) after insertion, and after pulling out(T3). Results The base points of inner diameter and volume of blood flow of CCA and ICA in group B were greater than those in group A(P<0.05). At T1 and T2 time points, the inner diameter of CCA of group A and group B decreased by9.5%-12.9% and 14.5%-24.3% respectively compared to T0(P<0.05 or P<0.01). Group B2 decreased significantly among groups. The inner diameter of ICA of group A2 and group B2 decreased by 10.9% and 16.3% respectively (P<0.05). The blood flow rate of CCA and ICA changed little (P> 0.05). The volume of blood flow of CCA of group A and group B decreased by 9.3%-10.7% and 12.2%-19.1% respectively compared to T0(P<0.05). Group B2 decreased significantly among groups. The volume of blood flow of ICA of group A and group B decreased by 10.0%-13.5% and 13.9%-16.6% (P<0.05) respectively. At T3 time point, the above indexes returned to T0 level. Conclutions The volume of blood flow and inner diameter of CCA and ICA decrease a little when using LMA, which decrease significantly in old patients, but blood flow rate changes little.