喉罩通气在腹腔镜下妇科手术中的临床应用效果  

Clinical efficacy of laryngeal mask airway in gynecological laparoscopic operation

作　　者：杨琦琳[1] 柴静[1] 余大松[1] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院麻醉科,上海200030

出　　处：《上海医学》2014年第2期116-120,共5页Shanghai Medical Journal

摘　　要：目的比较喉罩通气与气管插管在腹腔镜下妇科手术中的临床应用效果。方法 90例择期行腹腔镜下妇科手术的患者,美国麻醉医师学会分级Ⅰ或Ⅱ级,手术时间均<60min,随机分入气管插管组、单管喉罩组和双管喉罩组,每组30例。在麻醉诱导前(T0)、麻醉诱导后即刻(T1)、置喉罩或气管插管后即刻(T2)、置喉罩或气管插管后1min(T3)、人工气腹后即刻(T4)、人工气腹后15min(T5)、术毕(T6)、拔除喉罩或气管导管前(T7)、拔除喉罩或气管导管后(T8)各时间点,记录患者的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(petCO2)和气道峰值压(ppeak)。记录患者自主呼吸恢复时间、苏醒时间(术毕至呼之睁眼的时间)、拔管时间(术毕至呼吸恢复正常可拔除喉罩或气管导管的时间)和术中需追加丙泊酚的例数。记录术毕各组烦躁、咽喉疼痛的发生率及其程度,记录有无恶心呕吐、反流误吸等不良反应发生。结果与同组T0时间点比较,气管插管组在T7、T8时间点的SBP显著升高(P值分别<0.01、0.05),在T4、T7时间点的DBP显著升高(P值均<0.01),在T7、T8时间点的HR显著增快(P值分别<0.01、0.05);单管喉罩组和双管喉罩组在T4时间点的DBP显著升高(P值均<0.05)。气管插管组在T3、T7时间点的SBP和T7时间点的DBP均显著高于单管喉罩组和双管喉罩组同时间点(P值分别<0.01、0.05),在T2、T3、T4、T7、T8时间点的HR均显著快于单管喉罩组同时间点(P值分别<0.01、0.05),在T2、T4、T7、T8时间点的HR均显著快于双管喉罩组同时间点(P值均<0.01)。气管插管组有26.7%(8/30)的患者术中需追加丙泊酚,显著高于单管喉罩组和双管喉罩组的0(P值均<0.05)。气管插管组在T2至T7时间点的ppeak均显著高于单管喉罩组和双管喉罩组同时间点(P值均<0.05)。气管插管组的苏醒时间和拔管时间均显著长于单管喉罩组和双管喉罩Objective To compare the outcome of laryngeal mask airway versus tracheal intubation in laparoscopic gynecological surgery under general anesthesia. Methods Ninety patients, American Society of Anesthesiologist （ASA） grade I or II, scheduled for elective gynecological laparoscopy with the duration of procedure less than 60 minutes were randomly divided into three groups （n = 30） ： T （tracheal intubation） group, L1 （single-tube laryngeal mask airway） group, and L2 （proseal laryngeal mask airway） group. Parameters such as systolic blood pressure （SBP）, dystolic blood pressure （DBP）, heart rate （HR）, pulse oxygen saturation （SpO2）, pressure of end-tidal carbon dioxide （pet CO2）, and peak airway pressure （Ppeak） were recorded at To （before anesthesia）, T1 （immediately after anesthesia induction）, T2 （after mask placement or tracheal intubation）, T3 （ 1 minute after mask or tube placement）, T4 （immediately after pneumoperitoneum）, T5 （ 15 minutes after pneumoperitoneum）, T8 （at the end of the surgery）, T7 （before removal of mask or tube）, and T8 （after removal of mask or tube）. The time for recovery of spontaneous respiration, wakening, and ease of mask or tube as well as the cases of additional injection of propofol during the procedure, the incidence and severity of relevant perioperative and postoperative adverse events, including backflow, aspiration, nausea and vomiting, agitation, and throat pain were also monitored. Results As compared to the blood pressure at T0, SBP at T7 and T8 （P〈 0.01 and P〈0. 05, respectively） and DBP at T4 and T7 （both P〈0. 01） was markedly elevated with a significant increase of HR at T7 and T8 （ P〈0. 01 and P〈0. 05, respectively） in T group, while only DBP at T4 elevated in L1 and L2 groups （P〈0.05）. SBP at T3 and T7 and DBP at T7 in T group were significantly higher than those in L1 and L2 group （P〈0.01 and P〈O. 05, respectively）. The HR of T group at T2, T3, T4, T7 a

关 键 词：喉罩通气 气管插管 单管喉罩 双管喉罩 腹腔镜妇科手术 

分 类 号：R614[医药卫生—麻醉学]