无肌松喉罩通气全身麻醉在输尿管镜钬激光碎石术中的应用

Application of general anesthesia with laryngeal mask airway ventilation without muscle relaxation in ureteroscopic holmium laser lithotripsy

Key words:  喉罩  全身麻醉  输尿管镜  钬激光

Key words:  laryngeal mask  general anesthesia  ureteroscopy  holmium laser

Abstract:

目的 评估无肌松喉罩通气全身麻醉在输尿管镜钬激光碎石术(ureteroscopic holmium laser lithotripsy, URL)中应用的可行性和安全性。 方法 将2022年11月—2023年10月行URL的80例患者作为研究对象，随机分成肌松药组(M组)和无肌松药组(NM组)，每组40例。麻醉诱导药物如下: 静脉推注咪唑达仑0.03 mg/kg，舒芬太尼0.2 μg/kg，丙泊酚2 mg/kg。M组静注苯磺顺阿曲库铵0.1 mg/kg，NM组给予等容量的生理盐水。两组均插入喉罩机控通气。观察记录两组患者诱导前(T0)、置入喉罩即刻(T1)、置入喉罩后5 min(T2)、拔除喉罩即刻(T3)和拔除喉罩5 min(T4)的平均动脉压(mean arterial pressure, MAP)和心率(heart rate, HR)。记录并分析两组手术开始时和碎石完成时的气道压值、术中输液量、丙泊酚和瑞芬太尼的使用量、手术时间、自主呼吸恢复时间、呼唤睁眼时间、喉罩拔除时间和离室时间及不良反应情况。 结果 在T4时，NM组患者的HR明显高于M组(P<0.05)；两组患者手术开始时的气道压值、碎石完成时的气道压值、手术时间、术中输液量、丙泊酚用量和瑞芬太尼用量差异无统计学意义(P>0.05)；两组不良反应发生情况差异无统计学意义(P>0.05)；NM组自主呼吸恢复时间、呼唤睁眼时间、喉罩拔除时间和离室时间均明显短于M组(P<0.05)。 结论 无肌松喉罩通气全身麻醉可安全应用于URL，具有苏醒快，拔管早，离室时间短等优点，值得临床推广应用。

Abstract:

Objective To evaluate the feasibility and safety of general anesthesia with laryngeal mask airway without muscle relaxation in ureteroscopic holmium laser lithotripsy(URL). Methods A total of 80 patients who received URL from November 2022 to October 2023 were enrolled as research subjects. The patients were randomly divided into two groups: the group with muscle relaxation(group M) and the group without muscle relaxation(group NM), there were 40 cases in each group. The induction drugs were as follows: intravenous administration of midazolam 0.03 mg/kg, sufentanil 0.2 μg/kg, and propofol 2 mg/kg. Group M was injected intravenously with Cis-atracurium besylate 0.1 mg/kg, group NM was given the same amount of normal saline. Mechanical ventilation with laryngeal mask airway was performed in both groups. Mean arterial pressure(MAP) and heart rate(HR) were recorded before induction(T0), immediately after laryngeal mask airway(LMA) insertion(T1), 5 minutes after LMA insertion(T2), immediately after LMA removal(T3) and 5 minutes after LMA removal(T4) in both groups. Airway pressure was recorded at the beginning of surgery and at the end of lithotripsy in both groups. The amount of infusion, dosages of propofol and remifentanil were recorded in both groups. The time of operation, the recovery time of spontaneous breathing, the time of opening eyes, the time of removing laryngeal mask and the time of leaving the operating room were recorded in both groups. The adverse reactions of the two groups were recorded. Results At T4, the HR of patients in NM group was significantly higher than that in M group, and the difference was statistically significant(P<0.05). There was no significant difference in airway pressure at the beginning of operation and at the end of lithotripsy, operation time, intraoperative infusion volume, dosages of propofol and remifentanil between the two groups(all P>0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). The recovery time of spontaneous breathing, the time of calling eyes open, the time of pulling out laryngeal mask and the time of leaving the operating room in NM group were all significantly shorter than those in M group(all P<0.05). Conclusion General anesthesia with laryngeal mask ventilation without muscle relaxation can be safely applied to URL surgery, which has the advantages of quick awakening, early extubation and short post-surgery observation time, and is worthy of clinical application.