目的 比较经插管型喉罩(ILMA)气管内插管与经直视喉镜下(DLS)气管内插管时高血压患者的心血管反应及血管紧张素Ⅱ(AngⅡ)的变化.方法 选择择期行腹部手术的高血压患者120例,经医院伦理委员会审核通过,按随机数字表法随机分为插管型喉罩组(Ⅰ组)和经直视喉镜组(D组),比较两组患者气管内插管前后有创动脉压及血管紧张素Ⅱ(AngⅡ)的变化.结果 D组置人直视喉镜即刻(T4) Sp(123±9) mm Hg(1 mm Hg=0.133 kPa),Dp(71 ±9) mm Hg,AngⅡ(67±12) pg/ml.Ⅰ组置入插管型喉罩即刻(T4)Sp (105 ±7) mm Hg,Dp(64±6) mm Hg,AngⅡ(45±6) pg/ml.两组间有创动脉压与血管紧张素Ⅱ(AngⅡ)的变化Ⅰ组均显著小于D组,两组间比较P<0.05;两组气管插管完成即刻(T5)D组:Sp(125 ±7) mm Hg,Dp(72±8) mm Hg,AngⅡ(87±13) pg/ml.Ⅰ组Sp(112±6) mm Hg,Dp(63 ±5) mm Hg,AngⅡ(47±7)pg/ml.两组间有创动脉压与血管紧张素Ⅱ(AngⅡ)的变化Ⅰ组均显著小于D组,两组间比较P<0.05.结论 使用经插管型喉罩(ILMA)行气管内插管可显著降低高血压患者的心血管系统的剧烈反应,避免心血管意外的发生.
Objective To compare the variations of cardiovascular responses and vascular angiotensin Ⅱ (Ang Ⅱ ) in hypertensive patients during tracheal intubation with intubating laryngeal mask airway (ILMA) versus direct laryngoscope (DLS). Methods A total of 120 hypertensive patients undergoing abdominal surgery were randomly divided into 2 groups, i. e. intubating laryngeal mask airway (Group I ) and direct laryngoscope (Group D ). Variations of invasive arterial blood pressure and angiotensin Ⅱ were compared between two groups before and after intubation. Results The variations of cardiovascular responses and vascular angiotensin Ⅱ ( Ang Ⅱ) during tracheal intubation used of ILMA (T4) and DLS (T4) in an instant, tracheal intubation were immediately accomplished in two groups (T5). The variations of group I were significantly lower than those of group D ( P 〈 0. 05 ) . And statistical significance existed between two groups. Conclusion Tracheal intubation with intubating laryngeal mask airway (ILMA) can significantly reduce violent cardiovascular reactions and avoid cardiovascular accidents.