喉罩与气管插管全麻在帕金森病患者脉冲发生器植入术中的比较

doi:10.3969/j.issn.1006-7795.2025.05.009

首都医科大学学报 ›› 2025, Vol. 46 ›› Issue (5): 820-825.doi: 10.3969/j.issn.1006-7795.2025.05.009

喉罩与气管插管全麻在帕金森病患者脉冲发生器植入术中的比较

童媛媛,谢思宁,陈良,李享佳卉,韩如泉,熊蔚^*

首都医科大学附属北京天坛医院麻醉科，北京 100070

收稿日期:2025-07-01 修回日期:2025-08-13 出版日期:2025-10-21 发布日期:2025-10-22
通讯作者: 熊蔚 E-mail:gydxiognwei@126.com
基金资助:
贝恩麻醉科学研究项目(bnmr-2023-009)。

Comparison of laryngeal mask airway and endotracheal intubation general anesthesia for pulse generator implantation surgery in Parkinson's disease patients

Tong Yuanyuan, Xie Sining, Chen Liang, Li Xiangjiahui, Han Ruquan, Xiong Wei^*

Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2025-07-01 Revised:2025-08-13 Online:2025-10-21 Published:2025-10-22
Supported by:
This study was supported by Bethune Charitable Foundation (bnmr-2023-009).

摘要/Abstract

摘要： 目的分析喉罩与气管插管全身麻醉（以下简称全麻）在帕金森病脑深部电刺激术脉冲发生器植入（implantable pulse generator,IPG）手术中的应用效果。方法回顾性纳入2020年8月至2021年2月行IPG手术的164例帕金森病患者，按气道管理分为喉罩组（61例）与气管插管组（103例）。观察围术期各时相（诱导前、诱导后、切皮时、拔管时、入恢复室）平均动脉压（mean arterial pressure，MAP）、心率（heart rate，HR），比较拔管时间、术中低氧事件、喉罩转插管率及术后呼吸抑制、肺炎等并发症。结果喉罩组体质量指数显著低于气管插管组［（22.75±3.11) kg/m² vs (23.85±3.49) kg/m²，P=0.039］，其余基线均可比。诱导后喉罩组MAP下降幅度更小［（85.46±11.63) mmHg vs (74.13±11.78) mmHg，1 mmHg=0.133kPa,P<0.001］；拔管时插管组MAP更高［（98.27±13.78) mmHg vs (89.66±10.50) mmHg，P<0.001］。喉罩组术中血管活性药物使用率（3.3%）显著低于插管组（13.6%，P=0.032），平均拔管时间更短［（8.43±5.25) min vs (14.28±7.66) min，P<0.001］。两组患者围术期无低氧或喉罩转插管事件，术后呼吸抑制、肺炎等并发症差异无统计学意义。结论喉罩全麻可安全用于帕金森病IPG术，能缩短拔管时间、减少血管活性药物使用，且不增加插管相关并发症风险。

关键词: 帕金森病, 脉冲发生器植入, 喉罩, 气管插管, 全身麻醉, 脑深部电刺激术

Abstract: Objective To analyze the application effects of laryngeal mask airway (LMA) general anesthesia versus endotracheal intubation (ETI) general anesthesia in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) implantable pulse generator (IPG) surgery. Methods A retrospective analysis was conducted on 164 PD patients who underwent IPG surgery at our hospital from August 2020 to February 2021. Patients were divided into two groups based on airway management: LMA group (n=61) and ETI group (n=103). Perioperative hemodynamic parameters, including mean arterial pressure (MAP) and heart rate (HR), were observed at five time points: pre-induction (T0), post-induction (T1), skin incision (T2), extubation (T3), and post-anesthesia care unit (PACU) admission (T4). Key outcomes, such as extubation time, intraoperative hypoxia events, LMA-to-ETI conversion rate, and postoperative complications (respiratory depression, pneumonia), were compared between the two groups. Results The LMA group had a significantly lower body mass index than the ETI group ［(22.75±3.11 )kg/m² vs (23.85±3.49) kg/m², P=0.039］, while the other baseline characteristics were comparable. After induction, the LMA group exhibited a less decrease in MAP［ (85.46±11.63) mmHg vs (74.13±11.78) mmHg in the ETI group, P<0.001］. At extubation, the ETI group showed higher MAP ［(98.27±13.78) mmHg vs (89.66±10.50) mmHg in the LMA group, P<0.001］. The intraoperative use of vasoactive drugs was significantly lower in the LMA group (3.3%) than that in the ETI group (13.6%, P=0.032). The mean extubation time was shorter in the LMA group［ (8.43±5.25) min vs (14.28±7.66) min in the ETI group, P<0.001］. No intraoperative hypoxia or LMA-to-ETI conversion events occurred in either group. Postoperative respiratory depression and pneumonia rates showed no statistically significant differences between the groups. Conclusion LMA general anesthesia can be safely applied in PD patients undergoing DBS IPG implantation. It shortens extubation time, reduces the use of vasoactive drugs, and does not increase the risk of intubation-related complications.

Key words: Parkinson's disease (PD), , implantable pulse generator (IPG), laryngeal mask airway (LMA), endotracheal intubation (ETI), general anesthesia, deep brain stimulation

中图分类号:

R614

童媛媛, 谢思宁, 陈良, 李享佳卉, 韩如泉, 熊蔚. 喉罩与气管插管全麻在帕金森病患者脉冲发生器植入术中的比较[J]. 首都医科大学学报, 2025, 46(5): 820-825.

Tong Yuanyuan, Xie Sining, Chen Liang, Li Xiangjiahui, Han Ruquan, Xiong Wei. Comparison of laryngeal mask airway and endotracheal intubation general anesthesia for pulse generator implantation surgery in Parkinson's disease patients[J]. Journal of Capital Medical University, 2025, 46(5): 820-825.

参考文献

［1］ Bloem B R, Okun M S, Klein C. Parkinson's disease［J］. Lancet, 2021, 397(10291): 2284-2303.
［2］ Bucur M, Papagno C. Deep brain stimulation in Parkinson disease: a Meta-analysis of the long-term neuropsychological outcomes［J］. Neuropsychol Rev, 2023, 33(2): 307-346.
［3］李楠，王学廉. 脑深部电刺激疗法的发展历史和临床应用进展［J］. 空军军医大学学报, 2024, 45(12):1474-1477.
［4］朱美琳，程莉莉，董有静. 右美托咪定在脑电双频指数指导及全身麻醉下帕金森病脑深部电刺激术中的应用［J］. 中国医科大学学报, 2021,50(3):276-279.
［5］刘琰，李光宇，王晓旭，等. 帕金森病患者脑深部电刺激术后的非运动症状及其对生活质量的影响［J］. 中国医科大学学报, 2020, 49(1):43-47.
［6］ Sarica C, Iorio-Morin C, Aguirre-Padilla D H, et al. Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity［J］. Front Hum Neurosci, 2021, 15: 708481.
［7］ Ni Y, Xiao Y, Shen B, et al. Impact of deep brain stimulation on cognitive impairment in Parkinson's disease: a retrospective longitudinal study［J］. Neurotherapeutics, 2025, 22(3): e00561.
［8］ Nada E M, Rajan S, Grandhe R, et al. Intraoperative hypotension during second stage of deep brain stimulator placement: same day versus different day procedures［J］. World Neurosurg, 2016, 95: 40-45.
［9］刘志永, 丁翠青, 姚长青, 等. 帕金森病患者行下腹或下肢手术全麻苏醒质量及认知功能的变化［J］. 临床麻醉学杂志, 2015, 31(5): 472-475.
［10］ Chaki T, Koizumi M, Tachibana S, et al. Comparing leak pressure of LMA^® ProSeal^TM versus i-gel^® at head rotation: a randomized controlled trial［J］. Can J Anaesth, 2024, 71(1): 66-76.
［11］ Dilmaghani S, Atieh J, Khanna L, et al. Severity of dysphagia is associated with hospitalizations and mortality in patients with Parkinson's disease［J］. Neurogastroenterol Motil, 2022, 34(6): e14280.
［12］ Pinheiro Campos A C, Martinez R C R, Auada A V V, et al. Effect of subthalamic stimulation and electrode implantation in the striatal microenvironment in a Parkinson's disease rat model［J］. Int J Mol Sci, 2022, 23(20): 12116.
［13］ Lu W B, Chang X N, Bo L L, et al. Risk factors for delirium after deep brain stimulation surgery under total intravenous anesthesia in Parkinson's disease patients［J］. Brain Sci, 2022, 13(1): 25.
［14］ Lankhorst S, Keet S W M, Bulte C S E, et al. The impact of autonomic dysfunction on peri-operative cardiovascular complications［J］.Anaesthesia, 2015, 70(3): 336-343.［15］ Wachtendorf L J, Azimaraghi O, Santer P, et al. Association between intraoperative arterial hypotension and postoperative delirium after noncardiac surgery: a retrospective multicenter cohort study［J］. Anesth Analg, 2022, 134(4): 822-833.
［16］李军利, 刘楠楠. 气管插管全麻与喉罩通气全麻应用于脑血管动脉瘤介入栓塞患者的效果比较［J］. 河南医学研究, 2025, 34(1): 69-72.
［17］ Xing Y Q, Li Q, Xu E H, et al. Impaired cerebral autoregulation in Parkinson's disease: an orthostatic hypotension analysis［J］. Front Neurol, 2022, 13: 811698.
［18］ Gong Y H, Xu X H, Wang J, et al. Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial［J］. BMC Anesthesiol, 2020, 20(1): 16.
［19］ Sollmann M, LM Bode, S Krämer, et al. Superior recovery and efficiency with laryngeal mask airway compared to endotracheal intubation in minimally invasive repair of pectus excavatum: a retrospective analysis［J］. BMC Anesthesiol，2025，25(1):438.

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喉罩与气管插管全麻在帕金森病患者脉冲发生器植入术中的比较

Comparison of laryngeal mask airway and endotracheal intubation general anesthesia for pulse generator implantation surgery in Parkinson's disease patients

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