SLIPA^(TM)喉罩改良与传统置入法应用于全麻剖宫产术的临床观察  

Clinical observation of SLIPA^(TM) laryngeal mask improvement and traditional implantation in general anesthesia for caesarean section

作　　者：王玥[1] 康凯[1] 李杉[1] 白云波[1] 郭晓昱[1] WANG Yue;KANG Kai;LI Shan;BAI Yunbo;GUO Xiaoyu(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,北京100026

出　　处：《西部医学》2019年第5期698-701,706,共5页Medical Journal of West China

基　　金：首都医科大学附属北京妇产医院中青年学科骨干培养专项项目(FCYY201623)

摘　　要：目的探讨SLIPA喉罩改良置入法与传统置入法应用于全身麻醉剖宫产术的安全性及对术后并发症的影响。方法选择我院2016年4月～2017年11月间拟行择期全麻剖宫产手术的单胎足月妊娠产妇60例,采用随机数字表法分为改良置入组(G组)和传统置入组(C组),每组各30例。全麻诱导后按各自方法置入SLIPA喉罩。记录全麻诱导至胎儿娩出时间(ID)、子宫切开至胎儿娩出时间(UD)、手术时间和出血量;胎儿娩出时抽取脐动、静脉血进行血气分析,行新生儿1min、5min的Apgar及5d、7d的NBNA评分。记录首次置入时间、口咽漏气压;术中连续监测无创动脉压,记录置入及拔除喉罩各相关时间点的动脉血压和心率,术毕喉罩拔除后粘血、返流、误吸、咽痛、声音嘶哑等情况。结果两组产妇脐血血气与新生儿相关评分比较差异均无统计学意义(P>0.05);ID和UD时间均在安全范围内(P>0.05);与G组相比较,C组在置入和拔除喉罩即刻各时间点血流动力学变化明显(P<0.05);两组产妇术中均未发生反流、误吸(P>0.05);G组发生术后咽痛、声音嘶哑和罩体粘血较C组比较差异均有统计学意义(P<0.05)。结论 SLIPA喉罩改良置入法可明显提高置入成功率,气道密封较好,可安全用于择期全麻剖宫产术,不良反应少,值得临床借鉴。Objective To compare the safety and postoperative complications of two methods of SLIPA laryngeal mask and traditional placement in general anesthesia for cesarean section.Methods 60 cases of singleton pregnancy in general anesthesia for elective cesarean section maternal,ASA grade IIor III,28~43 years old,62 ~ 85kg,were randomly divided into modified implantation group (G group) and the conventional implantation group (C group),30 cases in each group.After the induction of general anesthesia,the SLIPA laryngeal mask was placed in their respective methods.The induction of general anesthesia to fetal childbirth time (ID),uterine incision to delivery time (UD),operation time and amount of bleeding were observed.The blood gas analysis of umbilical artery and vein blood were extracted from fetus.The packets of unsuspecting paediatricians,5min and Apgar in 1min 5D and 7d NBNA score were recorded.For the first time in record time,oropharyngeal leak pressure and intraoperative continuous monitoring of noninvasive arterial pressure were recorded.The time of pulling out the laryngeal mask of arterial blood pressure and heart rate,postoperative laryngeal mask after removal of blood viscosity,reflux,aspiration,sore throat and hoarseness were observed.Results There was no significant difference in the series of data related to operation and newborn ( P >0.05).The time of ID and UD were within the safety range.The first success rate in group G was 100%,and 4 cases in group C had the second successful implantation.Compared with the G group,the hemodynamic changes at each time point of the insertion and removal of the laryngeal mask were obvious in the C group ( P <0.05).Patients in the two groups were no regurgitation and aspiration.Conclusion SLIPA laryngeal mask improved placement method can significantly improve the success rate of implantation,and airway sealing is good.It can be safely used for elective general anesthesia cesarean section,with fewer adverse reactions.

关 键 词：剖宫产术 全身麻醉 SLIPA喉罩 术后并发症 

分 类 号：R719.8[医药卫生—妇产科学]