预给氧快速顺序诱导食管引流型喉罩全麻对腹腔镜胆囊切除术胃胀气的影响

Effects of Advancing to Oxygen Rapid Sequence Induction of General Anesthesia with Proseal Laryngeal Mask Airway on Gastric Insufflation in Laparoscopic Cholecystectomy

目的:观察预给氧快速顺序诱导食管引流型喉罩通气全麻对腹腔镜胆囊切除术中胃胀气的影响,及术后恶心呕吐发生率。方法实施手术的60例腹腔镜胆囊切除术患者ASAⅠ~Ⅱ,采用随机数字表法分为预给氧快速顺序诱导食管引流型喉罩组A组(30例)和正压给氧常规快诱导食管引流型喉罩组B组(30例)。观察气腹后胃胀气发生率及程度,记录胃胀气评分,影响手术操作置入胃管减压例数,随访术后恶心呕吐病例数。结果 A组无1例胃胀气(0%),视觉评分(3.86±1.48),B组胃胀气10例(33.3%),视觉评分(6.36±1.17),两组比较差异有统计学意义(<0.05);术中A组无1例置入胃管减压,B组有5例置入胃管减压,两组比较差异有统计学意义(<0.05);A组术后恶心呕吐1例,B组恶心呕吐6例,两组比较差异有统计学意义(<0.05)。结论预给氧快速顺序诱导食管引流型喉罩通气全麻用于腹腔镜胆囊切除术,能有效预防胃胀气,且通气功能良好,血流动力学平稳,术后恶心呕吐不良反应少。

Objective To observe effectiveness of advancing to oxygen rapid sequence induction of general anesthesia with proseal laryngeal mask airway(PLMA)on gastric insufflation in laparoscopic cholecystectomy surgery,the rates of nausea and vomiting after surgery.Methods Sixty ASAⅠ~IIpatients for adult undergoing laparoscopic cholecystectomy surgery,who were randomly divided into two groups,30 cases in each group.Group A were advanced to oxygen with no positive pressure ventilation before rapid sequence induction of anesthesia.Group B were given oxygen with positive pressure ventilation after rapid induction of anesthesia.Investigated and recorded the cases and dgree of flatulence after pneumoperitoneum,the cases of gastric tube through PLMA,the cases of nausea and vomting after surgery.Results There were no cases(0%)of gastric insufflation in group A,VAS(3.86±1.48),and 10 cases(33.3%)in group B,VAS(6.36±1.17),there was a significant difference between A and B(<0.05).There were no cases(0%)of inserting gastric tube in group A,and 5 cases of in group B,there was a significant difference between A and B(<0.05).There was one case of nausea and vomting in group A,6 cases of in group B,there was a significant between A and B(<0.05).Conclusion Advance to oxygen,rapid sequence induction of general anesthesia with PLMA in LC,can prevent gastric insufflation,provide good ventilation function and hemodynamic stability,in which complications were less.