喉罩用于全身麻醉下行腹腔镜胆囊切除术的临床观察  

Clinical observation of laryngeal mask used in laparoscopic cholecystectomy under general anesthesia

作　　者：龙浩[1] 杜晓宣[1] 独力坤[1] 

机构地区：[1]新疆医科大学第六附属医院,新疆乌鲁木齐830002

出　　处：《现代医药卫生》2013年第10期1458-1459,共2页Journal of Modern Medicine & Health

摘　　要：目的探讨全身麻醉下腹腔镜胆囊切除术喉罩替代气管导管的安全性和可行性。方法将美国麻醉师协会分级Ⅰ~Ⅱ级、体质量55～70 kg、择期行腹腔镜胆囊切除术的80例患者随机分为置入喉罩（LMA）组和气管插管（TT）组,每组40例。记录患者LMA或TT前后血流动力学变化,间歇正压通气20 min时和气腹20 min时的气道峰值（peak）、潮气量（VT）以及诱导前后血糖的变化。观察拔管反应（呛咳或挣扎反应）和术后咽痛情况。结果 LMA组患者诱导前后平均动脉压、心率低于TT组（P〈0.05）,两组患者插管时间,间歇正压通气20 min时和气腹20 min时的peak值、VT、呼气末二氧化碳分压比较,差异无统计意义（P〉0.05）。两组手术开始后各时间点的血糖较诱导前均显著增高,LMA组低于TT组（P〈0.01）。拔管时TT组70%（28/40）的患者出现呛咳或挣扎反应,术后4、24 h咽痛发生率分别为20%、25%,而LMA组均无拔管反应和术后咽痛。结论 LMA操作简单,不需颈部运动,不需喉镜,对患者刺激小,插管反应轻,适于高血压、冠心病患者。术后喉痛和咳嗽致喉部损伤发生可能性小,避免了术后喉水肿。Objective To discuss the safety and feasibility of the laryngeal mask airway （LMA） substituting for endotra- eheal intubation （TT） during general anesthesia in laparoscopic choleeystectomy. Methods 80 patients needing elective laparo- seopic eholecysteetomy,ASA Ⅰ~Ⅱ and weighing 55-70 kg, were selected and randomly divided into the LMA group and the TT group equally. The haemodynamic changes before and after LMA or TT, peak inspiratory airway pressure （peak）, tidal volume （VT）, and PTCO2 at 20 min during IPPV or pneumoperitoneum and variation of the blood sugar before and after induction were recorded. The extubation reactions（coughing or struggling reaction） and postoperative sore throat were observed. Results The MAP and HR before and after induction in the LMA group were lower than those in the TT group （P〈0.05）. There was no statisti- cal difference in Ppeak, VT, and PTCO2 at 20 min during IPPV or pneumoperitoneum between the two groups （P〉0.05）. The blood sugar at various timepoints after operation beginning was significantly higher than those before induction. The concentration of the blood sugar in the LMA group was lower than that in the TT group （P〈0.01）. 70% （28/40） cases in the TT group appeared coughing or struggling reaction during extubation, and the sore throat incidence at postoperative 2,24 h was 20% and 25% respectively. But the LMA group had no extubation reactions or postoperative sore throat. Conclusion LMA is simple to operate,needs not neck motion and laryngeal mirror, has small stimulation on patient and light intubation reaction and suits for the patients with high blood pressure and coronary disease. The possibility of throat injury caused by postoperative sore throat and coughing is small. Edema of the larynx can be avoided after operation.

关 键 词：胆囊切除术 腹腔镜 喉面罩 麻醉 全身 气管导管 

分 类 号：R657.4[医药卫生—外科学]