插管型喉罩在妇科腹腔镜手术麻醉中的临床应用  

Clinical application of intubating laryngeal mask airway in anesthesia during gynecologic laparoscopic surgery

作　　者：梁伟[1] 卢波[1] 周树强[1] 

机构地区：[1]广西玉林市妇幼保健院麻醉科,玉林市537000

出　　处：《广西医学》2016年第2期211-213,220,共4页Guangxi Medical Journal

基　　金：广西玉林市科学研究与技术开发计划(玉市科计2015020001)

摘　　要：目的探讨插管型喉罩用于妇科腹腔镜手术麻醉的可行性和安全性。方法择期行妇科腹腔镜手术患者60例,分为插管型喉罩组(Ⅰ组)和气管插管组(T组),每组30例,经静脉麻醉诱导后分别插入插管型喉罩或气管插管,记录两组插入喉罩(导管)成功率;记录插入前(T_1)、插入即刻(T_2)、插入后3 min(T3)、拔除喉罩(拔管)前(T_4)、拔除即刻(T_5)、拔除后3 min(T_6)的HR、收缩压(SBP)、舒张压(DBP);监测气道峰压(Pmax)、气道平均压(Pmean)、SpO_2、呼气末二氧化碳分压(P_(ET)CO_2),以及苏醒期躁动、术后呛咳、咽喉痛、声嘶等并发症的发生情况。结果两组插入成功率均为100%。两组SpO_2、Pmax、Pmean及P_(ET)CO_2比较,差异无统计学意义(P>0.05)。两组HR、SBP及DBP比较,差异有统计学意义(P<0.05),其中Ⅰ组的HR、SBP及DBP在T_2至T_6均明显低于T组,且在T_3、T_6分别基本恢复至T_2、T_5水平。Ⅰ组术后呛咳及声嘶的发生率低于T组(P<0.05)。结论插管型喉罩放置成功率高,诱导及苏醒期血流动力学平稳,术中通气情况良好,术后并发症少。Objective To investigate the feasibility and safety of intubating laryngeal mask airway （ILMA） for the anesthesia during gynecologic laparoscopic surgery. Methods A total of 60 patients undergoing selective gynecologic laparoscopic surgery were divided into ILMA group（ Group Ⅰ） and endotracheal intubation group（ Group T） ,with 30 cases in each group. After intravenous anesthesia induction, ILMA insertion and endotracheal intubation were conducted in Group Ⅰ and Group T respectively. The success rate of insertion with laryngeal mask/catheter were recorded in both groups. HR, systolic blood pressure（SBP） and diastolic blood pressure（DBP） were also recorded at 6 time points including before insertion（T1 ）,at the instance of insertion（T2 ）,3 minutes after insertion（T3 ）,before removal of ILMA/intubation （T4 ） , at the instance of removal （T5 ） and 3 minutes after removal （T6）. The peak airway pressure （Pmax） , mean airway pressure （Pmean ） , SpO2, end-tidal CO2 partial pressure（ PET CO2 ） and the complications including restlessness during recovery period, postoperative cough, throat pain and hoarseness ect. were monitored. Results The success rates of insertion were 100% in both groups. There was no significant difference in Pmax, Pmean, SpO2 or PET CO2 between two groups （P 〉 0.05 ）. There were significant differences in BP, SBP and DBP between two groups （P 〈 O. 05）. Group I had significantly lower BP, SBP and DBP from T2 to T6 compared to Group T, and all these indices of Group Ⅰ at T3 and T6 nearly declined to the levels of T2 and Ts respectively. Group Ⅰ achieved lower incidences of postoperative cough and hoarseness compared to Group T （ P 〈 0.05 ）. Conclusion ILMA obtains a high success rate of insertion, stable blood flow dynamics during the induction and recovery period, a good intraoperative ventilation and less postoperative complications.

关 键 词：全身麻醉 插管型喉罩 气管插管 妇科 腹腔镜手术 

分 类 号：R614.2[医药卫生—麻醉学]