食管引流型喉罩和标准型喉罩在腹腔镜胆囊切除手术麻醉中通气和呼吸力学的比较  

Comparision of proseal larnygeal mask airway and standard larnygeal mask airway under general anesthesia during laparoscopic cholecystectomy

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：《上海医学》2006年第8期565-568,共4页Shanghai Medical Journal

摘　　要：目的比较食管引流型喉罩(PLMA)和标准型喉罩(SLMA)在腹腔镜胆囊切除手术中的应用,观察通气效果及气腹前、中、后呼吸力学的变化,为临床安全有效地使用喉罩提供参考。方法选择美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级、择期行腹腔镜胆囊手术的患者60例,随机均分为PLMA组和SLMA组,两组均应用4号喉罩；PLMA组沿食管引流孔插入14号胃管。观察两组喉罩一次置入的成功率、漏气率、呼吸道密封压及胃胀气情况。以BicoreCP100多功能呼吸监护仪监测气腹前、后10 min及放气腹后5 min的呼气末二氧化碳分压(PETCO_2)、气道峰压(PIP)、气道阻力(Raw)和胸肺顺应性(CL)。结果SLMA组一次置入的成功率为96．7%,PLMA组为93．3%。插入时间SLMA组为(28±10)s,PLMA组为(39±15)s；呼吸道密封压SLMA组为(16±3)cm H_2O,PLMA组为(26±4)cm H_2O。PLMA组均成功插入胃管。SLMA组8例患者出现胃胀气,PLMA组无一例出现胃胀气。SLMA组漏气率明显高于PLMA组(P＜0．05),但气腹前、后漏气率的差异无显著性。两组患者气腹后PETCO_2、PIP、Raw均较气腹前明显升高(P＜0．05),CL明显降低(P＜0．05),但两组间差异无显著性。结论PLMA完全适用于腹腔镜胆囊切除手术,且与SLMA相比密封性更好,安全性更高。Objective To compare the proseal larnygeal mask airway （PLMA） with the standard laryngeal mask airway （SLMA） for ventilation and their respiratory mechanics during laparoscopic cholecystectomy. Methods Sixty patients scheduled for laparoscopic cholecystectomy were divided randomly into PLMA group （n = 30） and SLMA group （n= 30）. After anesthetic induction and PLMA （4#） or SLMA （4#） insertion, the ventilated tidal volume was set at 8-10 mL/kg with the velocity rate at 12/min. The first success rate, leakage, seal pressure were assessed. Respiratory mechanics were measured with Bicore CP-100 multifunction respiratory monitor, and peak inspiratory pressure （PIP）, airway resistance（Raw）, chest lung compliance （CL） were monitored at 3 distinct phases： before and 10 min after CO2 pneunmoperitoneum, and 5 min after the release of pneumoperitoneum. Results All patients were successfully ventilated through the assigned laryngeal masks. In the PLMA group, the first and third success rate were 87.5% and 98% respectively, and in SLMA group were 93.7% and 100% respectively. The time required to achieve effective airway was （39±15） s in PLMA group, and （28±10） s in SLMA group. The airway seal pressure was （26±4） cm H2O with PLMA and （16±3） cm H20 with SLMA. Gastric tube was successfully placed in PLMA group （100%）. During CO2 pneumoperitoneum, PIP, Raw and PETCO2 increased and CL decreased （P〈0.05） significantly. The SaO2 was well maintained at 100% throughout the whole course of surgery in both groups. There were no significant differences between the groups for effective ventilation. Conclusion It is nearly equivalent in safety and convenience to use PLMA and SLMA for laparoscopic cholecystectomy.Sometimes the former is even better clinically.

关 键 词：食管引流型喉罩 标准型喉罩 通气效果 呼吸力学 腹腔镜胆囊切除手术 

分 类 号：R614[医药卫生—麻醉学]