食管引流型喉罩在妇科腹腔镜手术中的应用  

Application of ProSeal laryngeal mask airway in gynecological laparoscopic surgery

作　　者：廖艺聪 贾俊香 LIAO Yicong;JIA Junxiang(Department of Anesthesiology,Women and Children's Hospital,School of Medicine,Xiamen university,Xiamen 361000,China)

机构地区：[1]厦门大学附属妇女儿童医院,厦门市妇幼保健院麻醉科,厦门市361000

出　　处：《临床麻醉学杂志》2020年第5期449-452,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察食管引流型喉罩应用于妇科腹腔镜手术的效果,评估其对胃内容物的影响。方法选择择期行妇科腹腔镜手术患者60例,年龄28~65岁,BMI 19~29 kg/m^2,ASAⅠ或Ⅱ级,根据是否经食管引流型喉罩置入引流管均分为置入引流管组(Y组)和未置入引流管组(N组)。全麻诱导待患者睫毛反射消失后行正压面罩通气180 s后置入食管引流型喉罩,Y组经喉罩置入引流管,N组未置入引流管。使用超声监测仪在面罩通气前(T0)、置入喉罩后(T1)和手术结束时(T2)测量并计算胃窦横截面积(CSA),计算T1与T0、T1与T2的CSA差值即ΔCSA1、ΔCSA2。记录两组患者和两组中胃进气患者T1-T2时CSA和ΔCSA1、ΔCSA2。记录腹腔充气前(T1a)、腹腔充气后(T2a)、头低脚高位后(T3a)时SpO2、PETCO2、气道峰压(Ppeak)等呼吸参数和术中是否经引流管引流出胃内容物。记录两组患者和两组中胃进气状态下术后6、12 h恶心呕吐发生情况。结果与T0时比较,T1时两组CSA明显增大(P<0.05),T2时N组CSA明显增大(P<0.05)。与T1时比较,T2时Y组CSA明显减小(P<0.05)。Y组ΔCSA2明显大于N组(P<0.05);N组胃进气患者ΔCSA1明显大于ΔCSA2(P<0.05)。Y组术中有4例引流出胃内液体。Y组胃进气患者术后6 h恶心呕吐发生率明显低于N组(P<0.05)。结论食管引流型喉罩用于妇科腹腔镜手术可以提供满意的气道密封效果。与未置入引流管比较,置入引流管可以在术中减轻麻醉诱导导致的胃进气程度、引流残留胃内容物、降低与胃进气相关的术后恶心呕吐发生率。Objective To observe the effect of ProSeal laryngeal mask in gynecological laparoscopic surgery under general anesthesia and evaluate its effect on gastric contents.Methods Sixty patients undergoing elective gynecologic laparoscopic surgery were selected,aged 28-65 years,BMI 19-29 kg/m 2,falling into ASA physical statusⅠorⅡ.According to whether the drainage tube was placed into the ProSeal laryngeal mask,these patients were randomly divided into two groups:the drainage tube placement group(group Y)and the drainage tube non-placement group(group N).After induction of general anesthesia,the patient′s eyelash reflex disappeared,and then apositive pressure facemask ventilation was performed for 180 s,and the ProSeal laryngeal mask was placed.Group Y was placed into the drainage tube through the laryngeal mask whereas group N was not placed into the drainage tube.The cross-sectional area(CSA)were measured and calculated before the mask ventilated(T 0),after the mask placed(T 1)and at the end of the procedure(T 2).The difference value of CSA between T 1 and T 0(ΔCSA 1),T 1 and T 2(ΔCSA 2)were calculated.The CSA,ΔCSA 1 andΔCSA 2 were compared between the two groups and patients with gastric insufflation in the two groups during T 0-T 2.SpO 2,P ET CO 2 and peak airway pressure(Ppeak)were measured before peritoneal insufflation with CO 2(T 1a),after peritoneal insufflation with CO 2(T 2a)and after adjusting the body position(T 3a),and whether the gastric contents were drained through the drainage tube during the operation.The incidence of nausea and vomiting at 6 and 12 h after surgery was recorded.Results Compared with T 0,the CSA of both groups were obviously increased at T 1(P<0.05),and the CSA of group N was obviously increased at T 2(P<0.05).There was no significant difference in CSA of group Y between T 0 and T 2.Compared with T 1,the CSA of group Y was reduced obviously.There was no significant difference in CSA of group N between T 1 and T 2.TheΔCSA 2 of group Y was increased obviously than that of grou

关 键 词：食管引流型喉罩 胃内容物 胃进气 超声 胃窦横截面积 

分 类 号：R614[医药卫生—麻醉学]