达米弱刺激通气型口垫在腹腔镜胃袖状切除术患者围术期气道管理的应用  

Application of Dami weakly stimulated oropharyngeal airway in perioperative airway management of patients undergoing laparoscopic sleeve gastrectomy

作　　者：陈丽丽 章蔚 夏敏[2] 王桂芝 吴昊[2] Chen Lili;Zhang Wei;Xia Min;Wang Guizhi;Wu Hao(Bengbu Medical College Graduate School,Bengbu 233000,China;不详)

机构地区：[1]蚌埠医科大学研究生院,蚌埠233000 [2]中国科学技术大学附属第一医院(安徽省立医院)麻醉科

出　　处：《中国临床保健杂志》2024年第1期80-84,共5页Chinese Journal of Clinical Healthcare

基　　金：中央级公益性科研院所基本科研业务费资助项目(2020-JKCS-007)。

摘　　要：目的探讨达米弱刺激通气型口垫(简称达米口垫)在腹腔镜胃袖状切除术患者围术期气道管理应用的安全性和有效性。方法选取2020年8月至2023年4月在中国科学技术大学附属第一医院(安徽省立医院)采用气管内全身麻醉腹腔镜胃袖状切除术的80例患者,采用随机数字表法分为2组:达米口垫组(D组)40例、口咽通气道组(C组)40例。麻醉诱导后,D组置入达米口垫,C组置入口咽通气道,面罩机械通气。气管插管前,取出口垫或通气道。气管插管后,D组再置入达米口垫,固定气管导管,C组固定气管导管于口角。手术结束气管拔管后,D组继续留置达米口垫,C组放置口咽通气道,直至取出。观察并比较不同时间点[入室(T 0)、气管插管后1 min(T 1)、拔管后5 min(T 2)、拔管后20 min(T 3)]2组患者生命体征、动脉血气分析、通气指标以及不良事件等。结果生命体征,与D组比较,C组T 2时平均动脉压、心率较高(P<0.05)。动脉血气,与D组比较,C组T 1、T 3时,动脉血二氧化碳分压较高(P<0.05);C组T 2、T 3时动脉血氧分压、pH值较低(P<0.05)。与D组比较,C组诱导期面罩正压通气潮气量/理想体重较低(P<0.05),调整通气道次数增多和麻醉恢复室停留时间较长(P<0.05),通气道留置时间较短(P<0.01);C组躁动发生率高于D组(P<0.05)。结论达米口垫可作为气管内全麻腹腔镜胃袖状切除术患者围术期的有效气道控制辅助装置,提高了围术期气道管理的安全性。Objective To explore the clinical significance of Dami weakly stimulated oropharyngeal airway(Dami airway)on laparoscopic sleeve gastrectomy in patients.Methods Eighty patients who underwent laparoscopic gastrectomy sleeve resection at the First Affiliated Hospital of USTC(Anhui Provincial Hospital)from August 2020 to April 2023 were selected and randomly divided into two groups:40 patients in Dami airway group(group D)and 40 in Oropharyngeal airway group(group C).In the group D,after induction,the Dami airway was placed in the mouth and taken out before tracheal intubation.It was placed again in the mouth during the operation.Oropharyngeal airway group(group C):after induction,Oropharyngeal airway was put into the mouth.It′s taken out before intubation and put again after extubation.In PACU(postanesthesia care unit),tow kinds of airway will be fixed till the patient wants it to be removed.The hemodynamic indexes and blood gas analysis indexes was recorded in different time,including baseline(T 0),1 minute after intubation(T 1),5 minutes after extubation(T 2)and 20 minutes after extubation(T 3).Safety indexes and adverse events were observed.Result Compared with group D,at T 2,HR and MAP of group C was higher(P<0.05).Compared with group D,at T 1 and T 3,PaCO 2 of group C was higher(P<0.05).And at T 2 and T 3,PaO 2 and PH of the two groups was lower(P<0.05).Compared with group D,V t/LBW(tidal volume per lean body weight)and the airway keeping time was lower(P<0.05)in group C.And PACU staying time was higher in group C(P<0.05).The incidence of agitation in group D was significantly lower than that in group C(P<0.05).Conclusions Dami weakly stimulated oropharyngeal airway can effectively keep obese patients′airway undergoing laparoscopic sleeve gastrectomy clear perioperation,thus reducing adverse reactions.

关 键 词：插管法 气管内 胃切除术 腹腔镜检查 气道管理 围手术期 

分 类 号：R656.61[医药卫生—外科学]