Supreme喉罩对老年全髋置换术患者气管插管反应的影响

Influences of Supreme laryngeal mask airway on tracheal intubation response in total hip replacement for older patients

摘要:

目的：探讨Supreme喉罩（Supreme laryngeal mask airway，SLMA）和气管内插管对老年全髋置换术全麻插管反应的影响。方法：美国麻醉医师协会（American association of anesthesiologists，ASA）分级Ⅰ～Ⅱ级、择期在全麻下行全髋置换术的老年患者50例，随机将病例分为喉罩（Laryngeal mask airway，LMA）组（L组，25例）和气管内插管组（T组，25例），麻醉诱导及维持方法相同，桡动脉穿刺连续有创监测收缩压（Systolic blood pressure，SBP）、舒张压（Ｄiastolic blood pressure，DBP）、心率（Heart rate，HR），分别记录２组麻醉诱导前（T0基础值）、插管（罩）后即刻（T1）、插管（罩）后5 min（T2）、插管（罩）后15 min（T3） SBP、DBP、HR，同时在以上各对应时点抽取静脉血，采用反相离子对色谱-电化学法检测血浆肾上腺素（Epinephrine，E）和去甲肾上腺素（Norepinephrine，NE）浓度，采用放射免疫分析法测定血清皮质醇（Cortisol，COR）的浓度。结果：2组病人性别、年龄及体质量均差异无统计学意义（P >0.05）。T组插管后T1、T2时SBP、DBP、HR明显升高（P<0.05），T1、T2时以上各指标明显高于L组（P<0.05），L组置SLMA后各时段SBP、DBP、HR无明显变化（P>0.05），至T3时2组SBP、DBP、HR均维持到T0水平（P >0.05）。T组E、NE浓度在T1、T2时较T0明显升高（P<0.05）且各对应时段高于L组（P<0.05）。T组T1、T2、T3时COR水平明显高于T0时和L组（P<0.01）。结论：SLMA可以有效减轻老年全髋置换术全麻时的应激反应，明显优于气管内插管。

Abstract:

Objective：To discuss the influence of Supremes laryngeal mask airway（SLMA） and tube intubation on total hip replace－ment for older patients under general anesthesia. Methods：Fifty elderly patients of Ⅰ-Ⅱbased on the grading of American Standards Association（ASA） were received selective radical total hip replacement under general anesthesia and were randomly allocated into two groups：laryngeal mask group（group L，n=25） and tube intubation group（group T，n=25）. Inducting and maintaining methods of general anesthesia were the same and radial puncture was made to monitor continuous systolic blood pressure（SBP），diastolic blood pressure（DBP） and heart rate（HR）. Values of SBP，DBP and HR of two groups were recorded before induction（T0，basic val－ues） and during tracheal intubation（LMA）（T1）and 5 min after tracheal intubation（LMA）（T2） and 15 min after tracheal intubation（LMA）（T3）. At the same time in the above the corresponding points，venous blood was extracted. Plasma concentrations of epinephrine（E） and norepinephrine（NE） were detected using reversed phase ion pair chromatography-electrochemical measurements and con－tent of blood serum cortisol（COR） was determined by radio-immunoassay. Results：There was no significant difference in sex，age and body quality between the two groups（P >0.05）. SBP，DBP and HR were increased significantly during T1 and T2 in group T（P<0.05） with each value significantly higher than those in group L（P<0.05）. There was no significant change in values of SBP，DBP and HR in group L after placing SLMA（P >0.05）. Values of SBP，DBP and HR at T3 were the same as those at T0 in the two groups（P >0.05）. Concentrations of E and NE were increased significantly at T1，T2 than at T0 in group T（P<0.05），higher than those in group L at the corresponding periods（P<0.05）. Levels of COR were higher at T1，T2 and T3 in group T than at T0 and in group L（P<0.01）. Conclu－sions：SLMA can effectively relieve the stress response of elderly patients with general anesthesia in total hip replacement，obviously better than the endotracheal tube.