文章摘要
Flexible喉罩在经鼻中隔-蝶窦入路垂体瘤切除术中的应用
Application of flexible laryngeal mask in transnaso sphenoidal microsurgery for pituitary adenoma
  
DOI：
中文关键词: Flexible喉罩  加强型气管导管  经鼻中隔-蝶窦入路  垂体瘤切除术
英文关键词: Flexible laryngeal mask  Reinforced endotracheal tube  Nasal septum-transsphenoidal approach  Pituitary tumor resection
基金项目:安徽省国际科技合作计划资助项目（1503062021）
作者单位
黄祥 230031,合肥市,安徽医科大学附属省立医院麻醉科 
冯芳 230031,合肥市,安徽医科大学附属省立医院麻醉科 
韩明明 230031,合肥市,安徽医科大学附属省立医院麻醉科 
朱冰青 230031,合肥市,安徽医科大学附属省立医院麻醉科 
康芳 230031,合肥市,安徽医科大学附属省立医院麻醉科 
李娟 230031,合肥市,安徽医科大学附属省立医院麻醉科 
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中文摘要:
      目的 观察Flexible喉罩 (flexible laryngeal mask airway，FLMA)用于经鼻中隔-蝶窦垂体瘤切除手术患者气道管理的效果及围术期应激反应的变化。方法 选择择期全麻下行经鼻中隔-蝶窦垂体瘤切除术患者100例，男71例，女29例，年龄18～65岁，BMI 21～28 kg/m2，ASA Ⅰ或Ⅱ级。随机分为两组:FLMA组 (F组)和加强型气管导管组 (T组)，每组50例。测定麻醉诱导前 (T0)、插入FLMA或气管导管即刻 (T1)、插入后1 min (T2)、5 min (T3)时血浆肾上腺素和去甲肾上腺素浓度;评估F组摆手术体位后和手术结束时气道暴露时纤维支气管软镜Berry评分并记录喉罩密封压;记录拔除FLMA或气管导管的时间及呛咳、喉痉挛、咽喉疼痛、声音嘶哑等不良反应发生情况。结果 T2、T3时F组血浆肾上腺素及去甲肾上腺素浓度明显低于T组 (P<0.05)。F组手术开始前和手术结束时气道暴露时纤维支气管软镜Berry评分差异无统计学意义。F组拔除喉罩时间明显短于T组拔管时间［(9±3)min vs (17±6)min］ (P<0.05)，拔除喉罩（气管导管）时呛咳(2% vs 22%)及拔除后咽喉疼痛(4% vs 30%)发生率明显低于T组(P<0.05)。结论 与加强型气管导管比较，FLMA可安全有效地应用于经鼻中隔-蝶窦入路垂体瘤切除手术，与麻醉相关的应激反应和并发症少，有助于术后恢复。
英文摘要:
      Objective To observe the effect of flexible laryngeal mask (FLMA) in transnaso-sphenoidal microsurgery for pituitary adenoma on airway management and variation of stress response. Methods One hundred patients (71 males, 29 females, aged 18-65 years, BMI 21-28 kg/m2, ASA physical status Ⅰ or Ⅱ) undergoing transnaso-sphenoidal microsurgery for pituitary adenoma were randomly divided into two groups: the FLMA group (group F) and the reinforced endotracheal tube group (group T) using a random number table, 50 cases in each group. The plasma concentration of epinephrine and norepinephrine were measured before anesthesia induction (T0), at the time of inserting the FLMA or reinforced endotracheal tube (T1), 1 min (T2) and 5 min (T3) after insertion. The Berry scores of the preoperative and postoperative airway exposure by branchofiberoscope in group F were assessed. The time of removal of FLMA (endotracheal tube) and the occurrence of choking, laryngeal spasm, sore throat, hoarseness and other adverse reactions were recorded. Results The levels of epinephrine and norepinephrine were were significantly lower at T2 and T3 in group F than those in group T (P<0.05). There was no significant difference in airway Berry scores. The time of extubation was shorter in group F than that in group T ［ (9±3) min vs (17±6) min］ (P<0.05). The incidence of choking (2% vs 22%) and sore throat (4% vs 30%) were significantly lower in group F than those in group T (P<0.05). Conclusion Compared with the reinforced endotracheal tube, FLMA can be applied safely and effectively to transnaso-sphenoidal microsurgery for pituitary adenoma, reduces stress respond associated with anesthesia and post-extubation complications, improves the recovery of patients.
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