Abstract:

Objective　To investigate the effect of placement of laryngeal masks at different concentrations of propofol by target controlled injection (TCI) on postoperative sore throat (POST) in patients undergoing daytime hysteroscopic surgery under general anesthesia with non-muscle relaxant laryngeal masks, and to search for a better combination of propofol and remifentanil TCI concentration in the effect room during the placement of laryngeal mask. Methods　One hundred and twenty-two patients who underwent daytime hysteroscopic surgery in First Hospital, Xiamen University from August 2019 to July 2020 were selected; they were 30-55 years old; their body weight was 48-65 kg. They were divided into P_3.0, P_3.5, and P_4.0 groups by the random number table method, with 42 cases in each group. The TCI concentrations in the propofol effect chamber during laryngeal mask implantation in the three groups were 3.0, 3.5, and 4.0 mg/L, respectively. The hemodynamic parameters and entropy indexes before and after laryngeal mask implantation, as well as the failure rates of laryngeal mask implantation, the presence of blood filaments on the mask surface after mask removal, scores of Visual Analogue Scale (VAS) 20 minutes (T0), 3 hours (T1), 6 hours (T2), and 24 hours (T3) after mask removal, and incidences of adverse reactions and VAS score>3 on the first, second, and third day after the surgery were compared between these three groups. Results　In the P_3.0 group, there were statistical differences in blood pressure, heart rate, reaction entropy, and status entropy between before and after laryngeal mask implantation [(72.48±9.46) mmHg (1 mmHg=0.133 kPa) vs. (79.14±11.68) mmHg, (65.40±9.02) beats/min vs. (71.50±9.69) beats/min, (56.62±9.12) vs. (62.24±11.48), and (53.02±8.73) vs. (58.62±11.33); t=2.88, 2.98, 2.48, and 2.54; all P<0.05]. The incidence of bloodstaining on the mask surface in the P_3.0 group [21.4% (9/42)] was higher than those in the P_3.5 [7.1% (3/42)] and P_4.0 [4.8% (2/42)] groups, with a statistical difference (χ²=6.91, P<0.05); The failure rate of first laryngeal mask implantation in the P_3.0 group [16.7% (7/42)] was higher than those in the P_3.5 [4.8% (2/42)] and P_4.0 [2.4% (1/42)] groups, with a statistical difference (χ²=6.73, P<0.05). The VAS scores at T1, T2, and T3 in the P_{3. 0} group were higher than those in the P_3.5 and P_4.0 groups (F=7.99, 10.49, 10.60; all P<0.05); the overall incidence of VAS score > 3 on the first day after surgery in the P_3.0 group [23.8% (10/42)] was higher than those in the P_3.5 [9.5% (4/42)] and P_3.0 [4.8% (2/42)] groups, with a statistical difference (χ²=7.45, P<0.05). Conclusion　When the concentration of TCI in the effective chamber of propofol reaches 3.5 mg/L and the TCI concentration in the effect chamber of remifentanil is 4.0 μg/L during daytime hysteroscopic surgery under general anesthesia without muscle relaxants, the placement of laryngeal mask has a low failure rate, low stress response, and a low incidence of POST, which is conducive to improving the anesthesia satisfaction of patients undergoing daytime hysteroscopy and rapid postoperative recovery.

Key words:

Propofol, Target controlled infusion, Hysteroscopic surgery, Postoperative sore throat, Laryngeal mask general anesthesia

摘要：

目的　探讨不同浓度异丙酚靶控输注（TCI）时置入喉罩对非肌松药喉罩全麻下行日间宫腔镜手术患者术后咽喉痛（POST）的影响，并寻找喉罩置入时较佳的异丙酚及瑞芬太尼效应室TCI浓度组合。方法　选择厦门大学附属第一医院2019年8月至2020年7月行日间宫腔镜的126例手术患者，年龄30～55岁，体质量48～65 kg，根据表格法随机将患者分为P_3.0组、P_3.5组、P_4.0组，每组各42例。3组患者喉罩置入时异丙酚效应室TCI浓度分别3.0 mg/L、3.5 mg/L和4.0 mg/L；比较P_3.0、P_3.5、P_4.0 3组患者喉罩置入前后血流动力学指标及熵指数、喉罩置入失败率、拔喉罩后喉罩表面带血丝情况、随访记录患者拔喉罩后20 min（T0）、3 h（T1）、6 h（T2）及24 h（T3）咽喉痛的视觉模拟评分法（VAS）评分并统计不良反应及术后第1、2、3天VAS评分>3分的发生率。结果　P_3.0组喉罩置入前后平均动脉压、心率、反应熵，状态熵比较［（72.48±9.46）mmHg（1 mmHg=0.133 kPa）比（79.14±11.68）mmHg、（65.40±9.02）次/min比（71.50±9.69）次/min、（56.62±9.12）比（62.24±11.48）、（53.02±8.73）比（58.62±11.33）］，差异均有统计学意义（t=2.88、2.98、2.48、2.54，均P<0.05）；喉罩表面带血丝发生率P_3.0组［21.4%（9/42）］高于P_3.5组［7.1%（3/42）］及P_4.0组［4.8%（2/42）］，差异有统计学意义（χ²=6.91，P<0.05）；P_3.0组首次喉罩置入失败率为16.7%（7/42），高于P_3.5组［4.8%（2/42）］及P_4.0组［2.4%（1/42）］，差异有统计学意义（χ²=6.73，P<0.05）；P_3.0组VAS评分在T1、T2、T3时，均低于P_3.5及P_4.0组（F=7.99、10.49、10.60，均P<0.05）；P_3.0组术后第1天VAS>3分的发生率为23.8%（10/42），高于P_3.5组［9.5%（4/42）］及P_4.0组［4.8%（2/42）］，差异有统计学意义（χ²=7.45，P<0.05）。结论　日间宫腔镜手术行非肌松药下喉罩全麻，当异丙酚效应室TCI浓度达到3.5 mg/L时联合瑞芬太尼效应室TCI浓度4.0 μg/L置入喉罩，置入失败率低、应激反应小、POST发生率低，有利于提高日间宫腔镜患者麻醉满意度及术后快速康复。

关键词:

异丙酚, 靶控输注, 宫腔镜手术, 术后咽喉痛, 喉罩全麻