CAJ | 학술논문

目的：评价三通喉罩(three-way laryngeal mask airway,TLMA)通气用于纤维支气管镜检查术对患者血流动力学和应激激素水平的影响。方法麻醉风险评估(ASA)Ⅰ~Ⅱ级的患者60例,按分层抽样原则分为3组(n =20)：局部麻醉组(A 组),全身麻醉内镜面罩通气组(B 组)及全身麻醉 TLMA 通气组(C 组)。3组均采用超声雾化器吸入2%利多卡因15分钟进行表面麻醉；B 组和 C 组静脉注射芬太尼1.0μg/kg、异丙酚1.5 mg/kg,微泵连续输注异丙酚6.0 mg·kg-1·h-1维持麻醉。B 组通过内镜面罩供氧,C 组插入 TLMA 控制呼吸。记录患者基础值(T0)、纤维支气管镜入声门前(T1)、入声门(T2)、入声门后3分钟(T3)、活组织检查(T4)、出声门(T5)时的心率(HR)、收缩压(SBP)、舒张压(DBP)和血氧饱和度(SaO 2)变化；应用高效液相色谱分析法测定静脉血浆肾上腺素(E)、去甲肾上腺素(NE)和多巴胺(DA)水平。结果 A 组 SBP、DBP 和 HR 在 T2、T3、T4、T5时均显著高于 T0(P <0.01),也显著高于B 组和 C 组(P <0.01)。A 组的 E、NE 和 DA 在 T2、T3、T4、T5时显著高于 B 组和 C 组(P <0.01)。结论纤维支气管镜检查术时,TLMA 通气效果满意,患者血流动力学和应激激素水平更稳定。
목적：평개삼통후조(three-way laryngeal mask airway,TLMA)통기용우섬유지기관경검사술대환자혈류동역학화응격격소수평적영향。방법마취풍험평고(ASA)Ⅰ~Ⅱ급적환자60례,안분층추양원칙분위3조(n =20)：국부마취조(A 조),전신마취내경면조통기조(B 조)급전신마취 TLMA 통기조(C 조)。3조균채용초성무화기흡입2%리다잡인15분종진행표면마취；B 조화 C 조정맥주사분태니1.0μg/kg、이병분1.5 mg/kg,미빙련속수주이병분6.0 mg·kg-1·h-1유지마취。B 조통과내경면조공양,C 조삽입 TLMA 공제호흡。기록환자기출치(T0)、섬유지기관경입성문전(T1)、입성문(T2)、입성문후3분종(T3)、활조직검사(T4)、출성문(T5)시적심솔(HR)、수축압(SBP)、서장압(DBP)화혈양포화도(SaO 2)변화；응용고효액상색보분석법측정정맥혈장신상선소(E)、거갑신상선소(NE)화다파알(DA)수평。결과 A 조 SBP、DBP 화 HR 재 T2、T3、T4、T5시균현저고우 T0(P <0.01),야현저고우B 조화 C 조(P <0.01)。A 조적 E、NE 화 DA 재 T2、T3、T4、T5시현저고우 B 조화 C 조(P <0.01)。결론섬유지기관경검사술시,TLMA 통기효과만의,환자혈류동역학화응격격소수평경은정。
Objective To evaluate the effects of three-way laryngeal mask airway (TLMA ) mechanical ventilation on the hemodynamics and stress responses of patients during bronchoscopy.Methods Sixty patients with ASA class Ⅰ or Ⅱ and undergoing bronchoscopy were divided into three groups according to the stratified sampling principle (n =20 each):topical anesthesia (group A),intravenous anesthesia with endoscopic mask ventilation (group B)and intravenous anesthesia with TLMA ventilation (group C).Topical anesthesia with 20 ml 2% lidocaine was applied for the patients in all the three groups.Patients in group B and group C also received intravenous injection with fentanyl (1.0 μg/kg ) and propofol (1.5 mg/kg ),followed by sustaining anesthesia with micropump actuated continuous injection of propofol (6.0 mg/kg · h).Heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure(DBP)and arterial oxygen saturation(SaO 2 )were continuously monitored during anesthesia and measured at 5 min after entering the surgery room(T0 ),just before the bronchoscope entering the glottis(T1 ),immediately after the bronchoscope entering the glottis(T2 ),3 min after the bronchoscope entering the glottis(T3 ),the time of biopsy(T4 ) and immediately after the bronchoscope extubated from the glottis(T5 ).Blood samples collected at T0 ,T1 ,T2 ,T3 ,T4 and T5 were used for the determination of plasma epinephrine(E),norepinephrine(NE)and dopamine(DA)using high performance liquid chromatography.Results SBP,DBP and HR in group A increased significantly at T2 ,T3 ,T4 and T5 as compared with those at baseline (P <0.01).They were also significantly higher than those in groups B and C at the corresponding time points (P <0.01).The levels of E,NE and DA in group A were significantly higher than those in groups B and C at T2 ,T3 ,T4 and T5 (P < 0.01 ).Conclusion TLMA is more effective in maintaining stable ventilation and stable hemodynamics and causing less stress responses during bronchoscopy.