喉罩囊内压对妇科腹腔镜手术患者术后快速康复的影响

Effect of laryngeal mask pressure on the rapid recovery of patients after gynecological laparoscopic surgery

目的探讨监测囊内压指导喉罩充气对妇科腹腔镜手术患者麻醉通气安全性和术后快速康复的影响。方法选取行妇科腹腔镜手术的患者132例,随机分为观察组和对照组,每组66例。观察组置入喉罩后应用测压表充气调节囊内压,使最终囊内压为口咽漏气压(OLP)达到20~30 cmH2O(1 cmH2O=0.098 kPa)时的最低值;对照组置入喉罩后凭手感判断,注入空气5~15 mL,使OLP达到20~30 cmH2O后,分别记录两组囊内压。两组患者喉罩置入成功后给予相同通气参数进行机械通气,记录两组喉罩置入操作用时和置入次数;术中记录最高气道峰压、喉罩漏气发生率和肌肉松弛药使用量;术后记录患者苏醒时间、胃管引流情况、拔喉罩时表面是否染血,以及咽喉部不适感、咽痛和胃胀等并发症的发生情况。结果观察组囊内压为(27.6±6.8)cmH2O,显著低于对照组的(76.8±14.2)cmH2O(P<0.05);观察组术后咽喉部不适感、咽痛和胃胀发生率均显著低于对照组(P值均<0.05)。术中,观察组患者因漏气共调整喉罩2次(3.03%),对照组共调整喉罩10次(15.15%),观察组调整喉罩次数显著少于对照组(P<0.05)。两组喉罩置入操作用时和置入一次成功率的差异均无统计学意义(P值均>0.05)。结论低囊内压喉罩充气既保证了麻醉通气的安全性,又减少了术后咽喉不适感、咽痛、胃胀等并发症的发生率,有利于促进患者术后快速康复。

Objective To explore the effect of laryngeal mask inflation under the guidance of intracuff pressure on the safety of anesthesia and postoperative rapid recovery in patients undergoing gynecological laparoscopic surgery.Methods A total of 132 patients undergoing gynecological laparoscopic surgery were randomly divided into observation group and control group(n=66).In the observation group,the oropharyngeal leakage pressure(OLP)was adjusted to 20-30 cmH2O(1 cmH2O=0.098 kPa)by manometer monitoring after insertion of laryngeal mask.In the control group,the OLP was adjusted to 20-30 cmH2O by the judgement of hand feeling and injecting the air(5-15 mL).The patients in the two groups were given mechanical ventilation with the same ventilation parameters after successful insertion.The time and times of insertion of laryngeal mask were recorded.The highest peak airway pressure,the incidence of leakage of laryngeal mask and the use of muscle relaxants were recorded during the operation.The recovery time,the drainage of gastric tube,whether the surface of laryngeal mask was stained with blood,the discomfort of pharynx and larynx,and the postoperative complications such as sore throat and bloated stomach were recorded.Results The intracuff pressure of the observation group was significantly lower than that of the control group when they had the same OLP([27.6±6.8]cmH2O vs.[76.8±14.2]cmH2O,P<0.05).The incidences of postoperative complications such as throat discomfort,pharyngeal pain and gastric distention in the observation group were significantly decreased as compared with control group(all P<0.05).Due to air leakage,the laryngeal mask was adjusted twice in the observation group(3.03%),which was significantly lower than that in the control group(10 times,15.15%,P<0.05).There was no significant difference in the time and times of laryngeal mask insertion between the two group(both P>0.05)Conclusion The low laryngeal mask pressure not only ensures the safety of anesthesia ventilation,but also reduces the incidence of postoperative complications such as discomfort,sore throat and distention of stomach,which is conducive to the rapid recovery of patients.