免充喉罩与气管内插管用于全身麻醉下经气管镜超声引导针吸活检的临床研究

Comparative analysis of inflatable-free laryngeal mask and endotracheal intubation for endo-bronchial ultrasound-guided transbronchial needle aspiration under general anesthesia

摘要:

目的 探讨免充喉罩与气管插管用于全身麻醉下经气管镜超声引导针吸活检（EBUS-TBNA）对患者围手术期血流动力学、气道峰压、麻醉恢复时间及围手术期不良反应的影响。方法 选择全身麻醉下行EBUS-TBNA的患者64例，随机分为喉罩组（L组，n = 32）和气管插管组（T组，n = 32）。观察两组患者麻醉诱导前（T₀）、诱导后插入喉罩/气管导管前（T₁）、诱导后插入喉罩/气管导管后即刻（T₂）、超声支气管镜置入即刻（T₃）、针吸活检时（T₄）、拔管即刻（T₅）和拔管后10 min（T₆）的血流动力力学变化；记录插入免充喉罩/气管插管后（P₁）、活检镜置入后（P₂）和拔出活检镜后（P₃）的气道峰压；记录两组患者呼吸恢复时间、清醒拔管时间、阿片类药物和顺式阿曲库铵使用量；比较两组患者围手术期不良反应发生率。结果 T组T₂和T₅时点收缩压（SBP）、舒张压（DBP）和心率（HR）均明显高于L组，差异有统计学意义（P < 0.05）；在P₂时点，T组气道峰压明显高于L组，差异有统计学意义（P < 0.05）；L组呼吸恢复时间与清醒拔管时间均短于T组，差异有统计学意义（P < 0.05）；T组瑞芬太尼使用量大于L组，差异有统计学意义（P < 0.05）；T组拔管躁动发生率高于L组，差异有统计学意义（P < 0.05）。结论 与气管插管相比，免充喉罩应用于全身麻醉下EBUS-TBNA，可维持血流动力学平稳，缩短麻醉恢复时间，是围手术期较为安全可行的麻醉管理方式。

Abstract:

Objective To compare the inflatable-free laryngeal mask and endotracheal intubation for endo-bronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under general anesthesia to hemodynamics, peak airway pressure, anesthesia recovery time and perioperative adverse reactions.Methods 64 patients with EBUS-TBNA under general anesthesia were randomly divided into the inflatable-free laryngeal mask group (Group L, n = 32) and the endotracheal intubation group (Group T, n = 32). Then observe the hemodynamic changes of patients before anesthesia induction (T₀), after anesthesia induction before intubation (T₁), immediately after insertion of the inflatable-free laryngeal mask/tracheal tube (T₂), immediately after ultrasound bronchoscopy insertion (T₃), immediately after needle aspiration (T₄), immediately after extubation (T₅), and 10 min after extubation (T₆); Then record the peak airway pressure after inserting the inflatable-free laryngeal mask/tracheal tube (P₁), after inserting the bronchoscope (P₂), and after extraction of the bronchoscope (P₃); record the breathing recovery time, extubation time, total dose of opioid and cisatracurium and perioperative period adverse reactions in two groups.Results Systolic pressure (SBP), diastolic pressure (DBP) and heart rate (HR) at T₂ and T₅ in group T were higher than those in group L (P < 0.05); The peak airway pressure at P₂ in the group T was higher than that in group L (P < 0.05); The breathing recovery time and extubation time in group L were shorter than those in group T (P < 0.05); The total dose of opioid in group T was higher than that in group L (P < 0.05); The incidence of the agitation in extubation period in group T was higher than that in group L (P < 0.05).Conclusion The inflatable-free laryngeal mask airway under general anesthesia is superior to endotracheal intubation in EBUS-TBNA which is easy to keep stable hemodynamics, and shorten the recovery time of anesthesia. It is a safe and feasible anesthesia management method in perioperative period.