清醒状态下置入喉罩在腹腔镜全子宫切除术中的应用  

Clinical studies about patients with laryngeal mask airway of laparoscopy total hysterectomy

作　　者：李继周[1] 贾文博 边步荣[1] 薛利军[1] 刘清玉[1] 罗瑞[1] 郭宇峰[1] 

机构地区：[1]榆林市第一医院麻醉科,陕西省榆林719000 [2]靖边县人民医院麻醉科

出　　处：《中国基层医药》2015年第21期3259-3262,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：观察镇静镇痛口舌咽表面麻醉清醒状态下置入喉罩用于腹腔镜全子宫切除术的临床效果。方法选择择期行腹腔镜全子宫切除术患者90例，按数字表法随机分三组，每组30例，观察组（A 组）：镇静、镇痛、充分表面麻醉下置入喉罩；对照1组（B 组）：全身麻醉快诱导后置入喉罩；对照2组（C 组）全身麻醉快诱导喉镜下插入气管导管。观察插管期和拔管期各组患者的反应、血流动力学变化、气腹1 h 血气及围术期并发症发生情况等。结果A 组拔管时平均动脉压（MAP）、心率（HR）分别为（92．7±10.6）mmHg、（82.8±12．1）次／min，B 组分别为（98．4±11．6）mmHg、（89．1±11．4）次／min，C 组分别为（111.2±12．5）mmHg、（104．1±13．2）次／min，A 组、B 组均优于 C 组（A 组与 C 组比较，t ＝6．18、6．52，均 P ＜0．01；B 组与 C 组比较， t ＝4．11、4．71，均 P ＜0．0）；A 组脉搏氧饱和度（SpO2）、气道峰压（Paw）分别为（99．6±0．4）％、（17．3±2．1）mmHg，B 组分别为（99．5±0．5）％、（17．6±2．0）mmHg，C 组分别为（99．5±0．5）％、（22．5±2．8）mmHg， A 组、B 组与 C 组比较差异均有统计学意义（A 组与 C 组比较，t ＝14．3、8．14，均 P ＜0．01；B 组与 C 组比较， t ＝12．7、7．78，均 P ＜0．01）；A、B、C 三组围术期并发症及不良反应发生率分别为27％、33％、67％，C 组显著高于 A 组、B 组（χ2＝9．64、6．67，均 P ＜0．01）。结论镇静镇痛表面麻醉清醒状态下置入喉罩用于腹腔镜全子宫切除术，能有效缩短全身麻醉时间，预防插管困难、紧急气道和围术期手术麻醉相关并发症。Objective To observe the sedation and analgesia in surface anesthesia in conscious glossopha-ryngeal LMA for the clinical effect of laparoscopic hysterectomy.Methods 90 patients undergoing elective laparo-scopic total hysterectomy were randomly divided into three groups,30 cases in each group.The observation group （group A）：sedation,analgesia,full surface anesthesia,control group 1 （B group）control group 2 （group C）were treated with endotracheal intubation under general anesthesia.At intubation and pull tube stage,the patients＇reaction, hemodynamic changes,pneumoperitoneum 1 h blood gas and perioperative complications were observed.Results The mean arterial pressure（MAP）and heart rate（HR）of A group were （92.7 ±10.6）mmHg and （82.8 ±12.1）/min. Those of B group were （98.4 ±11.6）mmHg,（89.1 ±11.4）/min,C group were （111.2 ±12.5）mmHg,（104.1 ± 13.2）/min,those in A group and B group were better than C group（A group and C group,t =6.18,6.52,P 〈0.01;B group and C group,t =4.11,4.71,all P 〈0.01）.The pulse oxygen saturation（SpO2 ）and peak airway pressure （Paw）of A group were （99.6 ±0.4）and （17.3 ±2.1）mmHg,those in group B were （99.5 ±0.5）% and （17.6 ± 2.0）mmHg,group C were （99.5 ±0.5）% and （22.5 ±2.8）mmHg.The differences between A group and B group were statistically significant（compared with C group,t =14.3,8.14,all P 〈0.01;B group and C group,t =12.7, 7.78,all P 〈0.01）.The incidence rates of perioperative complications and adverse reactions of A,B,C groups were 27%,33%,67%,that in C group was significantly higher than A group and B group（χ2 =9.64,6.67,all P 〈0.01）. Conclusion The laryngeal mask airway was used for laparoscopic total hysterectomy under the condition of sedation and analgesia,and it can shorten the time of the whole body,prevent the difficulty of intubation,emergency airway and anesthesia related complications.

关 键 词：腹腔镜检查 子宫切除术 麻醉和镇痛 

分 类 号：R713.42[医药卫生—妇产科学]