双管喉罩(LMA-Supreme)在妇科腹腔镜手术麻醉中的应用  

Application of LMA-Supreme in Gynaecologic Laparoscopic Operations Anesthesia

作　　者：蔡捍东[1] 孙剑[1] 

机构地区：[1]首都医科大学附属复兴医院,北京100038

出　　处：《中国医刊》2013年第10期35-36,共2页Chinese Journal of Medicine

摘　　要：目的探讨妇科腹腔镜手术在喉罩通气麻醉下的可行性和并发症的预防对策。方法随机选择100例需在全麻下完成的妇科腹腔镜手术患者，年龄24～51岁，平均34．5岁；体重48—68kg，平均58kg。术前检查无喉罩应用禁忌证，无心血管疾病和药物过敏史；术前常规禁食、水8小时，常规监测BP、ECG、SPO2、HR及脑电双频指数（BIS）。根据体重及身高选择3号或4号双管喉罩。静脉快速诱导，徒手盲探置入双管喉罩，置入成功后充气套囊压20cmH2O，并控制通气，听诊双肺呼吸音，检测胸肺顺应性及气道压力和有无漏气，同时监测呼末CO2分压及波形，证明无误后，固定喉罩机械通气8～10ml／kg；F13次／分。以吸入七氟醚，间断静脉舒芬太尼、罗库溴铵，静脉泵入瑞芬太尼维持麻醉和肌松。结果100例妇科腹腔镜手术治疗患者，98例均在双管喉罩通气麻醉下完成手术；其中徒手盲探1次置入成功87例；不能插入胃管需2次放气调整喉罩9例；3次以上调整2例；2例经反复调整仍通气不满意，而改气管内插管全麻。术后随访6例出现一过性咽喉痛；2例咽喉异物感；2例轻度声嘶，未经处理而愈。无反流、误吸及腹胀发生。结论引流式喉罩盲探插入全身麻醉可用于妇科腹腔镜手术，具有操作简单、应激反应轻、气道并发症少、术后并发症亦少等优点。只要正确掌握使用方法，完全能杜绝反流和误吸的发生，且通气效果确切，安全可靠，值得推广。Objective To investigate the feasibility and preventive measures of complications in patients undergoing gynaecologic laparoscopic operations with LMA-Supreme ventilation anesthesia. Method A total of 100 patients under- going gynaecologic laparoscopic operations （The age ranged from 24 to 51 years old, average 34.5 years old; weight 48 to 68 kg, with an average of 58 kg） in general anesthesia were randomly selected. They have no contraindications of LMA preoperative, no cardiovascular disease and allergic history, and not have anatomical deformities in maxillofa- cial and throat region. Nothing Per-os 8 hours, routine monitoring includes BP, ECG, SPO2, HR and BIS. We se- lected 3# or 4# LMA on the basis of weight and height. Anesthesia induction was intravenously injection： midazolam 0.01mg/kg, sufentanil 0.1 ~ 0.2μg/kg, rocuronium 0. 8 - 1mg/kg, propofol 2mg/kg. Blind placement LMA suc- cessfully, the pressure of cuff inflating was 20 cmH2 O, the two-sided auscultation lungs respiratory murmur was sym- metrical, detected paw airway pressure, end-expiratory CO2 waveform was normal, and then IPPV, tidal volume was 8 10ml/kg, frequency was 13 bpm. Sevoflurane was inhaled during operation, intermittent injected sufeutanil and rocuronium, continous intravenous pumping remifentanil. Trendelenbury position angle was less than 25 degree, CO2 pneumoperitoneum pressure was between 12 to 14 cmH20, CO2 pneumoperitoneum flow was 2L/min, operative time was controlled in 2 hours. Result 100 patients undergoing gynaecologic laparoscopic operations, 98 patients were in the use of LMA： 87 patients were placed with success rate of 100%, 9 patients needed second adjusting because of gastric tube cannot be placed, 2 patients needed third adjusting, and 2 patients needed ETI＂ after repeatedly adjus- ting. Results patients were followed up after operation, 6 patients had transient sore throat, 2 patients had pharynx ministry eyewinker feels, 2 patients had mild hoarseness, recovery with no treatment, no reflux, aspiration

关 键 词：妇科腹腔镜手术 喉罩通气麻醉 并发症 预防对策 

分 类 号：R614[医药卫生—麻醉学]