喉罩替换气管导管在高血压患者经皮肾镜碎石手术围拔管期的效果观察

　　[摘要] 目的 評价术毕喉罩替换气管导管在高血压患者经皮肾镜下碎石手术围拔管期间的运用效果。方法 观察2016年1月～2017年5月于我院择期行经皮肾镜下碎石手术合并高血压病患者40例，采用随机数字表法分为两组（n=20）：术毕将气管导管更换为喉罩组（LMA组）和未更换组（ETT组）。记录麻醉诱导前（T0）、术毕（T1）、拔管前（或喉罩）即刻（T2）、拔管（或喉罩）后即刻（T3）和拔管（或喉罩）后30 min（ T4）的血压、心率。记录苏醒期降压药使用情况。记录麻醉苏醒期间呛咳、恶心、呕吐、苏醒延迟和拔管（或喉罩）后咽痛、声音嘶哑等不良反应的发生。取T1和T3时的静脉血测血浆肾上腺素、去甲肾上腺素和皮质醇浓度。 结果 与ETT组比较，LMA组T2、T3和T4时间点血压和心率变化较小（P<0.05），麻醉苏醒期使用降压药的患者较少（P<0.05），呛咳、咽痛和恶心发生等不良反应发生率较少（P<0.05），LMA组T1和T3时血浆肾上腺素、去甲肾上腺素和皮质醇浓度较低（P<0.05）。 结论 喉罩替换气管导管在高血压患者经皮肾镜碎石手术围拔管期间的运用可明显降低拔管反应。
　　[关键词] 喉罩；高血压；围拔管期；经皮肾镜
　　[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2018）08-0112-04
　　Effect observation of laryngeal mask replacing the endotracheal tube hypertensive patients with percutaneous nephroscope lithotripsy operation during tracheal extubation period
　　LI Ping JIANG Ren QI Yong LI Hong HE Weiyi LI Qianjun CHEN Telei CHEN Wei
　　Department of Anesthesia，Ningbo Yinzhou NO.2 Hospital，Ningbo 315100，China
　　[Abstract] Objective To evaluate effect of laryngeal mask replacing endotracheal tube after surgery in hypertensive patients with percutaneous nephroscope lithotripsy operation during tracheal extubation period. Methods 40 hypertensive patients with percutaneous nephroscope lithotripsy operation between January 2016 and May 2017 in Zhejiang NingBo Yinzhou NO.2 Hospital， using the random number table method were divided into two groups（n=20）：laryngeal mask replacing the endotracheal tube after surgery group（LMA） and not replaced group （ETT）. Record before anesthesia induction（T0）， after sugery（T1）， immediately before extubation （or laryngeal mask） （T2）， or laryngeal mask immediately after extubation （T3） and tube drawing （or laryngeal mask） after 30 mins（T4）， blood pressure and heart rate. Record whether using antihypertensive drug during anesthesia recovery period. Record the occurrence of adverse reactions such as bucking， nausea， vomiting， delayed recovery， sore throat， and voice hoarse during anesthesia recovery period. To measure the venous blood plasma epinephrine， norepinephrine and cortisol levels at the time of T1 and T3. Results Compared with ETT group， the LMA group at T2， T3， and T4 time blood pressure and heart rate changed smaller （P<0.05）， less antihypertensive drug was used in patients （P<0.05）， less adverse reaction occurred such as choking cough， sore throat and nausea（P<0.05）， the LMA group plasma epinephrine， norepinephrine， and cortisol concentration were lower at the time of T1 and T3（P<0.05）. Conclusion Laryngeal mask replacing endotracheal tube in hypertensive patients with percutaneous nephroscope lithotripsy operation can obviously reduce the extubation reaction.

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