CAJ | 학술논문

目的：观察喉罩在喉气管裂开成形术中对病人血流动力学和应激激素水平的影响，评价喉罩在喉气管裂开成形术中的应用价值。方法：选择48例 ASAⅠ－Ⅲ级的喉气管狭窄择期手术的病人，按照随机数字表法分为喉罩组（A 组）和局麻气管切开组（B 组），每组24例。A 组：快速麻醉诱导后置入双管型喉罩，固定后行麻醉机控制呼吸，待气管切开后台上置入气管导管，拔除喉罩，通过气管导管行控制呼吸后继续手术。B组：先在局部麻醉下行气管切开置入气管导管，固定后行麻醉机控制呼吸继续手术。观察两组在麻醉诱导前（T0）、置入喉罩或气管切开置入气管导管即刻（T1）、置入喉罩后或气管切开置入气管导管后10min（T2）和置入喉罩后或气管切开置入气管导管后30min（T3）的 MAP、HR、SpO2变化。记录两组气管切开术中出血量、气管切开所需时间、误吸和气管痉挛的发生率。观察麻醉前（T4）、置入喉罩后或气管切开置入气管导管后即刻（T5）、喉气管裂开成形术术毕即刻（T6）和术后30min（T7）4个时点的应激激素水平。结果：B 组患者在 T1时点的 MAP、HR 明显高于 T0时点（P ＜0．01），T2、T3时点与 T0时点差异无统计学意义（P ＞0．05）；B组与 A 组比较，T1时点的 MAP、HR 明显升高（P ＜0．01）。与 B 组病人相比，A 组病人气管切开术的出血量明显减少，气管切开术时间缩短，未发生误吸及气管痉挛，不良事件少（P ＜0．05）。B 组自插管后各时间点的血糖均明显高于麻醉前（P ＜0．05），A 组在手术结束时血糖上升与麻醉前比较差异有统计学意义（P ＜0．01）；B组在 T6和 T7时点的血糖上升明显高于 A 组（P ＜0．05）。两组血皮质醇在 T6时点均高于 T4时点（P ＜0．05）；T7时点的血皮质醇 A 组下降，而 B 组继续上升，B 组与 A 组比较差异有统计学意义（P ＜0．05）。结论：与局部麻醉下气管切开置入气管导管通气相比，双管型喉罩通气应用于喉气管裂开成形术对患者血流动力学干扰小，不良反应少，引起的应激反应轻，同时能保证有效地通气，为喉气管狭窄患者提供了安全保障。目的：觀察喉罩在喉氣管裂開成形術中對病人血流動力學和應激激素水平的影響，評價喉罩在喉氣管裂開成形術中的應用價值。方法：選擇48例 ASAⅠ－Ⅲ級的喉氣管狹窄擇期手術的病人，按照隨機數字錶法分為喉罩組（A 組）和跼痳氣管切開組（B 組），每組24例。A 組：快速痳醉誘導後置入雙管型喉罩，固定後行痳醉機控製呼吸，待氣管切開後檯上置入氣管導管，拔除喉罩，通過氣管導管行控製呼吸後繼續手術。B組：先在跼部痳醉下行氣管切開置入氣管導管，固定後行痳醉機控製呼吸繼續手術。觀察兩組在痳醉誘導前（T0）、置入喉罩或氣管切開置入氣管導管即刻（T1）、置入喉罩後或氣管切開置入氣管導管後10min（T2）和置入喉罩後或氣管切開置入氣管導管後30min（T3）的 MAP、HR、SpO2變化。記錄兩組氣管切開術中齣血量、氣管切開所需時間、誤吸和氣管痙攣的髮生率。觀察痳醉前（T4）、置入喉罩後或氣管切開置入氣管導管後即刻（T5）、喉氣管裂開成形術術畢即刻（T6）和術後30min（T7）4箇時點的應激激素水平。結果：B 組患者在 T1時點的 MAP、HR 明顯高于 T0時點（P ＜0．01），T2、T3時點與 T0時點差異無統計學意義（P ＞0．05）；B組與 A 組比較，T1時點的 MAP、HR 明顯升高（P ＜0．01）。與 B 組病人相比，A 組病人氣管切開術的齣血量明顯減少，氣管切開術時間縮短，未髮生誤吸及氣管痙攣，不良事件少（P ＜0．05）。B 組自插管後各時間點的血糖均明顯高于痳醉前（P ＜0．05），A 組在手術結束時血糖上升與痳醉前比較差異有統計學意義（P ＜0．01）；B組在 T6和 T7時點的血糖上升明顯高于 A 組（P ＜0．05）。兩組血皮質醇在 T6時點均高于 T4時點（P ＜0．05）；T7時點的血皮質醇 A 組下降，而 B 組繼續上升，B 組與 A 組比較差異有統計學意義（P ＜0．05）。結論：與跼部痳醉下氣管切開置入氣管導管通氣相比，雙管型喉罩通氣應用于喉氣管裂開成形術對患者血流動力學榦擾小，不良反應少，引起的應激反應輕，同時能保證有效地通氣，為喉氣管狹窄患者提供瞭安全保障。
목적：관찰후조재후기관렬개성형술중대병인혈류동역학화응격격소수평적영향，평개후조재후기관렬개성형술중적응용개치。방법：선택48례 ASAⅠ－Ⅲ급적후기관협착택기수술적병인，안조수궤수자표법분위후조조（A 조）화국마기관절개조（B 조），매조24례。A 조：쾌속마취유도후치입쌍관형후조，고정후행마취궤공제호흡，대기관절개후태상치입기관도관，발제후조，통과기관도관행공제호흡후계속수술。B조：선재국부마취하행기관절개치입기관도관，고정후행마취궤공제호흡계속수술。관찰량조재마취유도전（T0）、치입후조혹기관절개치입기관도관즉각（T1）、치입후조후혹기관절개치입기관도관후10min（T2）화치입후조후혹기관절개치입기관도관후30min（T3）적 MAP、HR、SpO2변화。기록량조기관절개술중출혈량、기관절개소수시간、오흡화기관경련적발생솔。관찰마취전（T4）、치입후조후혹기관절개치입기관도관후즉각（T5）、후기관렬개성형술술필즉각（T6）화술후30min（T7）4개시점적응격격소수평。결과：B 조환자재 T1시점적 MAP、HR 명현고우 T0시점（P ＜0．01），T2、T3시점여 T0시점차이무통계학의의（P ＞0．05）；B조여 A 조비교，T1시점적 MAP、HR 명현승고（P ＜0．01）。여 B 조병인상비，A 조병인기관절개술적출혈량명현감소，기관절개술시간축단，미발생오흡급기관경련，불량사건소（P ＜0．05）。B 조자삽관후각시간점적혈당균명현고우마취전（P ＜0．05），A 조재수술결속시혈당상승여마취전비교차이유통계학의의（P ＜0．01）；B조재 T6화 T7시점적혈당상승명현고우 A 조（P ＜0．05）。량조혈피질순재 T6시점균고우 T4시점（P ＜0．05）；T7시점적혈피질순 A 조하강，이 B 조계속상승，B 조여 A 조비교차이유통계학의의（P ＜0．05）。결론：여국부마취하기관절개치입기관도관통기상비，쌍관형후조통기응용우후기관렬개성형술대환자혈류동역학간우소，불량반응소，인기적응격반응경，동시능보증유효지통기，위후기관협착환자제공료안전보장。
Objective:By observing the influencing of laryngeal mask in the laryngeal tracheal rupture for patients'blood flow dynamics and the stress hormone levels,to explore the clinical value of laryngeal mask in the laryngeal tra-cheal rupture.Methods:Forty -eight patients,ASA I to Ⅲand scheduled for laryngeal tracheal rupture,were random-ly divided into two groups:Laryngeal mask group(group A,n =24)and trachea incision under local anesthesia group (group B,n =24).In group A,proSeal laryngeal mask were performed after anesthesia induction,then anesthesia ma-chine controlled breath.After tracheotomy,endotracheal tube was inserted and anesthesia machine controlled breath. Then pull out the laryngeal mask.In group B,tracheotomy was performed after local anesthesia and then endotracheal tube intubation.Anesthesia machine controlled breath.The mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2 )were investigated and recorded on the following time points:Prior to the inductional anesthe-sia(T0),after LMA or endotracheal tube intubation(T1),10min after PLMA or endotracheal tube intubation(T2), 30min after PLMA or endotracheal tube intubation(T3).The amount of bleeding,time using,aspiration and tracheo-spasm were recorded in tracheotomy between the two groups.Levels of stress hormones were recorded at the following time points:Prior to the inductional anesthesia(T4),after LMA or endotracheal tube intubation(T5),after laryngeal tracheal rupture plasty(T6)and 30min after laryngeal tracheal rupture plasty(T7).Results:In group B,the MAP and HR at T1 point were significantly higher than the T0 point(P <0.01).T2 and T3,compared with T0,there was no statistically significant difference(P >0.05).At T1 point,the MAP and HR in group B were significantly higher than that of group A(P <0.01).Compared with group B,bleeding volume,time using and the incidence of aspiration and tracheospasm were less in group A(P <0.05).Compared with T4,blood glucose was significantly higher at other time points(P <0.05).In group A,blood glucose to rise was statistically significant at the T6 point compared with that of T4 point (P <0.01).In group B,the time point of T6 and T7 blood glucose were higher than that of group A(P<0.05).At T6 time point,the serum cortisol was higher than T4(P <0.05).At T7 point,compared with B there was statistically significant in group A(P <0.05).Conclusion:Compared with tracheotomy after local anesthesia and then inserting into endotracheal tube,PLMA applied to laryngeal tracheal rupture for patients,has less influence on hemo-dynamics,less adverse reaction,cause of less stress reaction,at the same time can guarantee the effective ventilation, providing security for laryngotracheal stenosis patients.