Guardian喉罩用于术前置入鼻胃管的腹腔镜胆囊切除术患者气道管理的效果  

Efficacy of laryngeal mask airway Guardian for airway management in patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy

作　　者：石妤[1] 左明章[1] 杨宁[1] 贾瑞芳[1] 孟晓燕[1] 

机构地区：[1]北京医院麻醉科,100730

出　　处：《中华麻醉学杂志》2017年第1期100-103,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价Guardian喉罩用于术前置入鼻胃管的腹腔镜胆囊切除术患者气道管理的效果.方法 择期全麻下拟行腹腔镜胆囊切除术患者60例,性别不限,ASA分级Ⅰ-Ⅲ级,年龄26～64岁,体重48～ 95 kg,Mallampati分级Ⅰ-Ⅲ级,采用随机数字表法分为2组（n=30）：Ⅰ组经Guardian喉罩引流管放置胃管,Ⅱ组术前经鼻放置胃管并术中保留,置入Guardian喉罩后经喉罩引流管放置胃管.术中监测血流动力学指标、SpO2、PETCO2和气道峰压（Ppeak）.置入成功后行纤维支气管镜检查评分,记录胃管位移的发生情况;记录喉罩置入时间、首次置入成功情况、喉罩密封压、罩体周围漏气和胃管引流情况.拔除喉罩后记录罩体内是否有血液或反流物,通过pH值试纸测定喉罩尖端及罩体背侧和腹侧的pH值.记录术后24 h内咽部不良反应的发生情况.结果 2组术中血流动力学平稳,SpO2、Ppeak均在正常范围,Ppeak低于喉罩密封压,组间比较差异无统计学意义（P＞0.05）;2组喉罩置入时间、首次置入成功率、喉罩密封压、口咽部解剖结构显露评分、咽部不良反应情况、麻醉用药量、罩体内带血及反流物的发生情况,术后喉罩尖端及罩体的背侧和腹侧pH值比较差异无统计学意义（P＞0.05）.胃管引流情况：Ⅰ组患者经喉罩放置的胃管引流率为67％;Ⅱ组患者经鼻放置的引流管引流率为40％,经喉罩引流管放置的胃管引流率为50％.Ⅱ组患者术后经鼻胃管未发生位移.结论 对于术前置入鼻胃管的腹腔镜手术患者,Guardian喉罩易于置入,其气道密封性可靠,通气效果好,能安全有效地用于该类患者的气道管理.Objective To evaluate the efficacy of laryngeal mask airway （LMA） Guardian for airway management in the patients requiring insertion of nasogastric tube before laparoscopic cholecystectomy.Methods Sixty patients of both sexes,aged 26-64 yr,weighing 48-95 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with Mallampati grade Ⅰ-Ⅲ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were divided into group Ⅰ and group Ⅱ （n =30 each） using a random number table.In group Ⅰ,the nasogastric tube was inserted through the drain tube of LMA Guardian.In group],the nasogastric tube was inserted through the nostril before operation,and after successful LMA Guardian placement,another nasogastric tube was inserted through the drain tube of LMA Guardian.The hemodynamic parameters,SpO2,end-tidal pressure of carbon dioxide and peak airway pressure （Ppeak） were monitored during operation.The fiberoptic laryngoscopy scores were assessed after successful LMA placement,and the nasogastric tube displacement was recorded.The LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,occurrence of air leakage of LMA and nasogastric tube drainage were recorded.The bloodstains and gastroesophageal reflux were observed after removal of the LMA.The pH values were tested at the tip of LMA and on the dorsal and ventral sides of the body of LMA using pH test papers.The development of adverse reactions in the oropharynx was recorded within 24 h after operation.Results The hemodynamics was stable,the SpO2 and Ppeak were within the normal range during operation,and Ppeak was lower than airway sealing pressure in the two groups （P〉0.05）,and there was no significant difference between the two groups.There was no significant difference between the two groups in the LMA placement time,success rate of LMA placement at first attempt,airway sealing pressure,score for exposure of oropharynx,development of adverse reactions in the oropharynx,consumption of

关 键 词：喉面罩 呼吸 人工 插管法 胃肠 腹腔镜检查 

分 类 号：R614[医药卫生—麻醉学]