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多功能喉罩与气管插管在日间手术小细胞肝癌经皮射频消融术中的应用比较
A comparison of multi-function intubating laryngeal mask and tracheal intubation in the percutaneous radiofrequency ablation of ambulatory surgery for small hepatocellular carcinoma under general anesthesia
- 中国癌症杂志 2018年28卷第1期 页码：69-74
- 作者机构：
复旦大学附属肿瘤医院麻醉科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
DOI：10.19401/j.cnki.1007-3639.2018.01.010
中图分类号： R735.7-
网络出版：2018-02-07，
纸质出版：2018-02-07
- 稿件说明：
移动端阅览
孔令超,缪长虹,陈万坤,等. 多功能喉罩与气管插管在日间手术小细胞肝癌经皮射频消融术中的应用比较[J]. 中国癌症杂志, 2018, 28(1): 69-74.
孔令超, 缪长虹, 陈万坤. A comparison of multi-function intubating laryngeal mask and tracheal intubation in the percutaneous radiofrequency ablation of ambulatory surgery for small hepatocellular carcinoma under general anesthesia[J]. China Oncology, 2018, 28(1): 69-74.
孔令超,缪长虹,陈万坤,等. 多功能喉罩与气管插管在日间手术小细胞肝癌经皮射频消融术中的应用比较[J]. 中国癌症杂志, 2018, 28(1): 69-74. DOI： 10.19401/j.cnki.1007-3639.2018.01.010.
孔令超, 缪长虹, 陈万坤. A comparison of multi-function intubating laryngeal mask and tracheal intubation in the percutaneous radiofrequency ablation of ambulatory surgery for small hepatocellular carcinoma under general anesthesia[J]. China Oncology, 2018, 28(1): 69-74. DOI： 10.19401/j.cnki.1007-3639.2018.01.010.
摘要
背景与目的：经皮射频消融术(percutaneous radiofrequency ablation，PRFA)治疗小细胞肝癌(small hepatocellular carcinoma，HCC)效果得到认可并在日间手术室得到广泛开展。随着加速康复外科(enhanced recovery after surgery，ERAS)概念的兴起，选择合适的麻醉方法变得日益重要。比较多功能喉罩(multi-function intubating laryngeal mask，multi-function ILM)与气管插管在日间手术PRFA中的麻醉安全性。方法：择期全麻下经皮肝脏射频消融术患者140例，随机分为多功能喉罩组(A组)和气管插管组(B组)，记录并比较两组患者在麻醉诱导前(T
0
)、插入喉罩/气管导管前(T
1
)、插入喉罩/气管导管即刻(T
2
)、插入后5 min(T
3
)、10 min(T
4
)、15 min(T
5
)、拔出喉罩及气管导管即刻(T
6
)的收缩压(systoLnc blood pressure，SBP)、舒张压(diastoLnc blood pressure，DBP)及心率(heart rate，HR)，同时记录平均气道压(P
mean
)、气道峰压(P
peak
)和P
ET
CO
2
，并观察呛咳、反流误吸、躁动、气道分泌物、拔管后低氧血症及咽喉疼痛等并发症，记录苏醒时间及患者术后满意度。结果：A组插入喉罩及气管导管即刻(T
2
)的SBP、DBP及HR显著低于B组，波动更小，差异有统计学意义(P0.05)；两组的苏醒时间差异有统计学意义(P0.05)，A组苏醒更快；A组患者气道分泌物增多、喉咙疼痛等并发症明显少于B组，差异有统计学意义(P0.05)，两组各时点通气效果、术中不良反应发生率及经济效益差异无统计学意义(P0.05)。结论：多功能喉罩在行PRFA日间手术麻醉中通气效果良好，术后并发症少，安全可靠。对患者血流动力学影
响较小，血压波动较小。苏醒期时间更短，有提高患者满意度、降低患者治疗时间的可能，在日间手术中有一定的优势。
Abstract
Background and purpose: Percutaneous radiofrequency ablation (PRFA) for the treatment of small hepatocellular carcinoma (HCC) has been widely accepted and used in the ambulatory surgeries. With the development of enhanced recovery after surgery (ERAS)
it is becoming more and more important to choose an appropriate method of anesthesia. This study aimed to compare the safety of the multi-function intubating laryngeal mask (multi-function ILM) with tracheal intubation in PRFA of ambulatory surgeries under general anesthesia. Methods: One hundred and forty patients scheduled for PRFA of ambulatory surgery for HCC under general anesthesia were randomized into two groups with 70 cases respectively: multi-function ILM (A) group and tracheal intubation (B) group. The data ［systoLnc blood pressure (SBP)
diastoLnc blood pressure (DBP)
heart rate (HR)
P
mean
P
peak
and P
ET
CO
2
］ of the patients in the two groups were recorded and compared at different time points: before anesthesia induction (T
0
)
before intubation or multi-function ILM insertion (T
1
)
immediately after (T
2
) and 5 min after (T
3
)
10 min after (T
4
)
15 min after (T
5
) intubation or multi-function ILM insertion
extubation or multi-function ILM removal (T
6
). Meanwhile we observed the bucking
regurgitation and aspiration
dysphoria
increased airway secretions
hypoxemia after extubation
postoperative sore throat. The awakening time and patients’ satisfaction scores were recorded. Results: The SBP
DBP and HR of patients at the moment of multi-function ILM insertion/intubation (T
2
) in group A were significantly lower with smaller fluctuation compared with group B (P0.05). The awakening time of patients in group A was significantly shorter than that of those in group B (P0.05). The incidences of c
ompLncations such as increased airway secretions and postoperative sore throat in group A were significantly less compared with group B (P0.05). There was no statistically significant difference in the effect of machine ventilation
the incidence of intraoperative compLncation and the medical economic benefit between the two groups at different time points. Conclusion: The appLncation of multi-function ILM in the PRFA of ambulatory surgeries for HCC has good effect of ventilation
less postoperative compLncations
and proved to be safer and more reliable. In addition
it has less impact on hemodynamics of patients and patients’ blood pressure would be more stable. The awakening time will also be shorter than that of patients with tracheal intubation. Therefore
the appLncation of multi-function ILM has advantages in the PRFA of ambulatory surgeries over tracheal intubation under general anesthesia as it can shorten the awakening time
improve patient satisfaction and reduce the time of treatment.
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