改良快速顺序诱导联合i-gel喉罩在腹腔镜胆囊切除术中的应用
Application of the modified rapid sequence induction combined with laryngeal mask airway i-gel in laparoscopic gallbladder surgery
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摘要: 目的:观察改良快速顺序诱导联合i-gel喉罩在腹腔镜胆囊切除术(LC)中对患者诱导期血流动力学及手术区视野评级的影响。方法:择期LC患者80例,随机分为改良快速顺序诱导组(M组)和常规快速诱导组(C组)各40例。M组患者采取分次给药、不行人工正压通气的诱导方法,C组患者采取常规静脉快速诱导。2组患者均在麻醉诱导前局麻下行桡动脉穿刺,测直接动脉压,生化监测。2组患者诱导给药速度均为1 ml/s,术中补液速度均为10 ml·kg-1·h-1。记录2组患者麻醉诱导前、麻醉诱导后2 min、喉罩置入后1min和5min各时点的心率、平均动脉压、脉搏血氧饱和度、动脉氧分压及动脉二氧化碳分压的变化,并对手术区视野进行评级。结果:在诱导期间M组血流动力学较C组稳定。M组手术区视野评级优良率高于C组(P<0.05)。结论:与常规快速诱导法相比较,M组患者的血流动力学更平稳,无缺氧和二氧化碳蓄积,适用于LC的全麻诱导,且避免了诱导时返流误吸、术中胃肠道积气等并发症,有着良好的临床应用前景。Abstract: Objective: To observe the effects of the modified rapid sequence induction combined with laryngeal mask airway(LMA) i-gel on the hemodynamics during induction period and surgical site grade in laparoscopic gallbladder surgery.Methods: Eighty laparoscopic cholecystectomy patients scheduled by laparoscopic gallbladder surgery were randomly divided into the modified rapid sequence induction group(group M)and conventional rapid induction(group C)(40 cases each group).The group M were induced with gradation dose combined without artificial positive pressure ventilation,the group C were induced with conventionally intravenous way.The arterial pressure and biochemical indexes in two groups were detected by radial artery puncture under local anesthesia before anesthesia induction.The speeds of the injection and transfusion were 1 ml/s and 10 ml·kg-1·h-1 in two groups,respectively.The heart rate,mean arterial pressure,pulse oxygen saturation,arterial blood oxygen partial pressure and arterial blood CO2 partial pressure of two groups were recorded at the time of pre-induction,post-induction 2 min,post-insertion LMA 1min and 5min,and the operation field was rated.Results: Compared with group C during induction,the hemodynamics of group M was stable.The fineness rate of the operation field grade in group M was higher than that in group C(P<0.05).Conclusions: Compared with the conventional rapid induction,the modified rapid sequence induction is stable hemodynamics and no lack of oxygen and carbon dioxide accumulation,which is suitable for induction in laparoscopic gallbladder surgery,can avoid the reflux,aspiration and gastrointestinal flatulence,and has a good prospect of clinical application.
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[1] 徐四七, 王胜斌.改良快速顺序诱导气管插管期间应激反应的观察[J].安徽医科大学学报[J].2013, 48(11):1352-1354. [2] 胡胜红, 徐四七.改良快速顺序诱导用于快速康复外科全麻患者的效果观察[J].山东医药, 2013, 53(27):42-44. [3] Brown JPR,Werrett G.Bag-mask ventilation in rapid sequence induction[J].Anaesthesia,2009,64(7):784-785. [4] Reich DL,Hossain S,Krol M,et al.Predictors of hypotension after induction of general anesthesia[J].Anesth Analg,2005,101(3):622-628. [5] Wilmore DW,Kehlet H.Management of patient in fast track surgery[J].BMJ,2001,322(2):473-476. [6] 刘 展, 汪晓东, 李立.多学科协作诊治模式下的结直肠外科快速康复流程[J].中国普外科基础与临床杂志, 2007,14(2):239-241. [7] 刘展, 汪晓东, 李立.结直肠外科快速康复模式加速直肠癌术后康复的临床研究[J].中华胃肠外科杂志, 2008,11(6):551-553. [8] 王刚, 孙备, 姜洪池, 等.快速康复外科在胆道外科中应用的初探[J].中华肝胆外科杂志, 2009,15(1):31-33. [9] 周潮平, 张亚铭, 宋玉庆, 等.快速康复外科在远端胃癌Billroth 1式手术中的临床应用[J].安徽医学, 2011,32(8):1071-1073. [10] Edmark L,Kostova-Aherdan K,Enlund M,et al.Optimal oxygen concentration during induction of general anaesthesia[J].Anesthesiology,2003,98(1):28-33. [11] 孙彦懿, 多晓东, 单世民.维库溴铵先注原则作为气管插管用药的临床观察[J].齐齐哈尔医学院学报, 2001,22(6):628. [12] 中华医学会麻醉学分会.肌肉松弛药合理应用的专家共识(2013)[J].临床麻醉学杂志, 2013,29(7):712-714. [13] Alanoｑlu Z,Ates Y,Yilmaz AA,et al.Is there an ideal approach for rapid-sequence induction in hypertensive patients?[J].J Clin Anesth,2006, 18(1):34-40. [14] 王忱, 刘怀萍.喉罩在腹腔镜胆囊切除术全身麻醉中的应用[J].汕头大学医学院学报, 2002, 15(3):158-159. [15] 段宏军, 贾瑞芳, 时迎斌, 等.i-gel喉罩用于腹腔镜胆囊手术患者气道管理的效果[J].中华麻醉学杂志, 2010,30(7):806-807. [16] 郭颍, 郑立东.i-gel喉罩在老年患者腹腔镜胆囊切除术全身麻醉中的应用[J].蚌埠医学院学报, 2012,37(7):790-792. -
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