双管型喉罩在全麻剖宫产术中的应用  

The application of proseal laryngeal mask airway in general anesthesia for cesarean section

作　　者：周玲[1] 潘建辉[1] 柴小青[1] 

机构地区：[1]安徽医科大学附属省立医院麻醉科,合肥市230001

出　　处：《临床麻醉学杂志》2013年第3期244-246,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨双管型喉罩在全麻剖宫产手术麻醉中应用的效果。方法择期全麻剖宫产手术患者60例,随机均分为双管型喉罩组(A组)和气管插管组(B组),分别给予丙泊酚1～1.5mg/kg(1min)、瑞芬太尼1μg/kg及维库溴铵0.08mg/kg静脉注射麻醉诱导,并持续静脉输注丙泊酚2～4mg·kg-1·h-1和瑞芬太尼6～10μg·kg-1·h-1,间断吸入七氟醚维持麻醉。记录插管(喉罩)前(T0)、插管(喉罩)后1min(T1)、3min(T2)、拔管(喉罩)前(T3)、拔管(喉罩后)1min(T4)、3min(T5)时的SBP、DBP、HR。记录T1～T3时且VT=8ml/kg时的平均气道压(Pmean)、气道峰压(Ppeak)和PETCO2。记录插管(喉罩)成功率及术中有无反流误吸情况,记录术后咽喉部并发症。结果 T1、T3、T4时B组HR明显快于,SBP、DBP明显高于T0时及A组(P<0.05)。T1～T3时A组Pmean、Ppeak明显低于B组(P<0.05)。两组术中均无反流误吸发生。术后咽部不适A组2例(6.7%)明显少于B组的9例(30.0%)(P<0.05)。结论双管型喉罩通气用于全麻剖宫产手术安全可行,与气管插管比较,具有一定的优越性。Objective To explore the feasibility and advantages of proseal laryngeal mask airway in obstetric anesthesia for cesarean section. Methods Sixty patients scheduled for selective cesarean section under general anesthesia were allocated randomly to either proseal laryngeal mask airway group （group A） and endotreacheal intubation group （group B） with mechanial ventilation. Anesthesia was induced by dexamethasone 10 mg, propofol 1-1.5 mg/kg （ 1 min）, remifentanyl 1 l μg/kg and vecuronium 0.08 mg/kg. After anesthesia induction, continuous intravenous propofol 2-4 mg·kg^-1·h^-1 and remifentanyl 6-10 mg·kg^-1·h^-1 were given, discontinuous sevofiurane was used to maintain appropriate anesthesia depth. SBP, DBP and HR were recorded before intubation （T0）, at 1 min （T1） and 3 rain （T2） after intubation, before extubation （T3）, at 1 rain （T4） and 3 rain （T5） after extubation. Pmean, Ppeak and PETCO2 were measured at T1-T3 in two groups under the tidal volume 8 ml/kg, respectively. And to observe the success rate of ventilation devices placement in two groups, as well as the incidence of intraoperative aspiration of reflux and postoperative throat complications. Results In group B, SBP, DBP and HR at T1,T3,T4 were significantly higher than those at T0 and in group A（P〈0.05）. Pmean, Ppeak were significantly lower in group A than those in group B at T1- T3（P〈0.05）. Postoperative throat discomfort incidence in group A was 6. 7G, which was significantly less than that in group B （30%） （P〈0.05）. No aspiration occurred in the two groups. Conclusion Proseal laryngeal mask airway led to less cardiovascular stress, more effective ventilation, and few complications of throat after operation compared to endotracheal intubation technique in patients undergoing cesarean section.

关 键 词：双管型喉罩 气管插管 全麻 剖宫产 

分 类 号：R614[医药卫生—麻醉学]