对比不同气管插管方法对全麻妇科手术患者应激反应的影响

Effect of the Different Tracheal Intubation Methods on Stress Reaction in Patients Undergoing Gynecologic Operation with General Anesthesia

摘要: 目的：观比较传察统喉镜(MAC)，插管型喉罩(ILMA)，光棒引导气管插管对全麻妇科手术患者应激反应的影响。方法：选择择期全麻下行妇科手术患者90例，年龄35~60岁，ASA分级I~II级，Mallampati气道分级I~II级。随机平均分为传统喉镜组 (n = 30)，喉罩组 (n = 30)，光棒组 (n = 30)。观察比较三组于诱导前(T0)，插管后1 min (T1)，3 min (T2)，5 min (T3)四个时相平均动脉压(MAP)，心率(HR)，血糖(GLU)，皮质醇(COR)的变化，并进行统计学分析。结果：T0时相三组各项观察指标比较均无差异(P > 0.1)；气管插管后T1时相A组，B组MAP，HR均较T0时有明显增高(P < 0.01)，C组MAP，HR变化幅度不明显(P > 0.05)，无统计学差异；A组MAP，HR在T2时仍未降至T0水平(P < 0.01)，B组在T2时降至T0水平(P > 0.05)；T1~T3时相，A组，B组血糖及皮质醇水平均较T0时明显增高(P < 0.01)，C组血糖，皮质醇水平在T1升高(P < 0.01)，但较快(T3)回落到插管前(T0)水平(P > 0.05)。T3时项组间比较A,B两组该指标均高于C组，差异有统计学意义(P < 0.05)；插管时间C组明显短于A，B两组(P < 0.01)。结论：相对于传统喉镜和插管型喉罩等需与部广泛接触的插管方式而言，光棒引导气管插管不仅缩短了插管时间，而且对全麻妇科手术患者的血流动力学影响较轻，可明显降低应激反应程度。

Abstract: Objective: Comparing the traditional laryngoscope (MAC), intubation laryngeal mask (ILMA), the flexible light wand guided tracheal intubation effects on stress reaction in patients undergoing Gynecological operation with General anesthesia. Methods: 90 patients undergoing Gynecologic operation with General anesthesia were randomly divided into three groups: the traditional la-ryngoscope group (n = 30), intubation laryngeal mask group (n = 30), the flexible light wand guided group (n = 30); aging between 35 - 60, ASA I-II, Mallampati airway classification I-II. HR, MAP, GLU, COR were recorded before induction (T0), 1 min (T1), 3 min (T2), 5 min (T3) after intubation. Result: At T1, HR and MAP were significantly higher than those at T0 in group A and B (P < 0.01), but there was no significantly change in group C (P > 0.05). T1 to T3, the GLU and COR were significantly increased (P < 0.01) in group A and B. In group C, the GLU and COR increased at T1 (T < 0.01), but rapidly fell back to normal level (T0) (P > 0.05). At T3, all the observation indexes of group A and B were higher than group C’s (P < 0.05). Intubation time of group C was significantly shorter than that of group A and B (P < 0.01). Conclusion: Compared with the traditional laryngoscopy and intubation laryngeal mask, flexible light wand guided tracheal intubation not only shortens the intubation time, but also has lighter influence on hemodynamics of patients undergoing gynecological operation; this can significantly reduce the stress reaction degree.