食管引流型喉罩在腹腔镜胆囊手术麻醉中的应用  

Application of proSeal laryngeal mask airway during laparoscopic cholecystectomy under anesthesia

作　　者：史东平[1] 祝义军[1] 封卫征[1] 闻大翔[2] 杭燕南[2] 

机构地区：[1]上海交通大学医学院附属仁济医院嘉定分院麻醉科,201800 [2]上海交通大学医学院附属仁济医院麻醉科

出　　处：《临床麻醉学杂志》2006年第7期511-513,共3页Journal of Clinical Anesthesiology

摘　　要：目的比较食管引流型喉罩(PLMA)和气管插管(IT)在腹腔镜胆囊切除手术中的通气效果,观察气腹前、中、后呼吸力学和血液动力学变化,为临床安全有效的使用喉罩提供参考。方法选择腹腔镜胆囊切除手术病人80例,随机均分为两组,PLMA组和IT组;PLMA组全部应用TOKIBO4号PLMA,沿食管引流管插入14号胃管,IT组应用7·5号气管导管;测定呼吸道密封压,连续监测并记录五个不同时间点的SBP、DBP、HR、SpO2、PETCO2、气道峰压(PIP)、气道阻力(Raw)、胸肺顺应性(CL)。结果PLMA组一次成功率87·5%(34例),二次成功率10%(4例),三次成功率2·5%(2例);IT组一次成功率90%(36例),二次成功率10%(4例)。两组均无失败病例。PLMA组呼吸道密封压平均为(24·50±6·81)cmH2O;气腹前、中、后漏气率差异无显著意义。插入及拔除喉罩或气管导管时,IT组血液动力学变化较PLMA组明显(P<0·05)。两组病人气腹后较气腹前相比:PETCO2、PIP、Raw明显升高(P<0·05);CL明显降低(P<0·05)。结论PLMA通气完全适用于腹腔镜胆囊切除手术,并发症少,安全性和有效性较高。Objective To compare proseal laryngeal mask airway with intratracheal tube during laparoscoplc cholecystectomy under general anesthesia. Methods Eighty ASA Ⅰ-Ⅱ adult patients undergoing elective laparoscopic cholecystectomy（LC） were randomly divided into proSeal laryngeal mask airway group （PLMA, n= 40） and intratracheal intubation group （IT n = 40）. In group PLMA, size 4 PLMA was used and in group IT the size 7.5 tracheal tube. ECG, SpO2, SBP, DBP , HR and PETCO2 were monitored and PIP,Raw, CL measured by Bicore CP-100 respiratory monitor. Results PLMA and tracheal tubes in two groups were inserted successfully and gas leak did not occur in all patients. The time required for insertion of PLMA and IT was averaged 24.2 and 22.7, respectively the airway seal pressure in group PLMA was （24.50 ±6.81） cmH2O. Hemodynamics had no change significantly during PLMA insertion or extubation, which was changed significantly during IT insertion or extubation. During pneumoperitoneum, PET CO2, PIP, Raw increased and CL decreased significantly in two groups. Conclusion It is safe and convenient to use PLMA for ventilation with effective ventilation, stable anesthesia and less complication.

关 键 词：食管引流型喉罩 气管插管 呼吸力学 血液动力学 

分 类 号：R614[医药卫生—麻醉学]