喉罩通气全麻在单孔胸腔镜手术中的临床应用

Clinical application of laryngeal mask airway for patients in uniportal video-assisted thoracoscopic surgery performed under general anesthesia

关键词:  喉罩  双腔气管插管  单孔胸腔镜手术

Key words:  laryngeal mask  double-lumen intubation  single hole thoracoscopic surgery

摘要:

目的 探讨喉罩通气全麻在单孔胸腔镜手术中的临床应用价值。方法 选取2018年6月至2019年5月接受单孔胸腔镜手术的患者40例，随机分成喉罩组（A组）和双腔气管插管组（B组），通过观察麻醉前（T1），插管/喉罩时（T2），手术开始时（T3），拔管/喉罩时（T4）及术后2小时（T5）的平均动脉压、心率和血氧饱和度以及麻醉时间、清醒时间、复苏时呛咳发生率，术后咽部不适、手术时间、平均住院天数等临床指标，比较两种方式的整体效果。结果 喉罩组麻醉时间及复苏时间短于插管组（P<0.05），插管/喉罩时血压及心率波动喉罩组小于插管组（P<0.05），复苏时呛咳及术后咽部不适喉罩组发生率低于插管组（P<0.05），而手术时间、住院天数等指标差异无统计学意义（P>0.05）。结论 在严格选择病例的前提下，喉罩通气麻醉在单孔胸腔镜手术中，在麻醉时间、对血流动力学的影响及术后不良反应等方面优势明显，符合加速康复的理念，有较高的临床应用价值。

Abstract:

Objective To investigate the clinical value of laryngeal mask airway (LMA) compared to double-lumen endotracheal tube (DLT) for patients in single hole thoracoscopic surgery. Methods Totally 40 patients, who underwent single hole thoracoscopic surgery in our hospital from June 2018 to May 2019, were enrolled and randomized into two groups:LMA group (A) and DLT group (B). Several vital parameters, including mean arterial pressure, heart rate and oxygen saturation were recorded at five time-points:before anesthesia (T1), at the time of LMA/intubation (T2), the beginning of surgery (T3), after LMA/extubation (T4) and two hour after surgery (T5). Clinical parameters such as anesthesia time, recovery time, cough cardiopulmonary resuscitation, postoperative pharyngeal discomfort, operative time, and average length of stay in the hospital were collected. Results Blood pressure and heart rate fluctuation in group A were less than group B at T2 (P<0.05). The anesthesia time, recovery time, cough cardiopulmonary resuscitation and postoperative pharyngeal discomfort in group A were lower than those in group B, while the operative time and average length of stay in the hospital were similar (P>0.05). Conclusions LMA is superior to DLT for patients under video-assisted thoracoscopic surgery in terms of anesthesia time, hemodynamics and postoperative adverse reactions. If confirmed, these results should have the value of clinical practice in the field of accelerated rehabilitation.