腹腔镜胆道手术患者双管型喉罩通气的可行性

The use of ProSeal laryngeal mask airway for mechanical ventilation during laparoscopic biliary tract surgery

目的探讨双管型喉罩(PLMA)用于腹腔镜胆道手术患者通气的可行性。方法择期行腹腔镜胆囊切除术或腹腔镜胆总管探查术患者80例,年龄21-63岁,ASA Ⅰ或Ⅱ级,随机分为PLMA组和气管导管(TT)组,每组40例。用纤维支气管镜观察PLMA的到位情况。记录患者插管时、插管后3min、拔管时和拔管后3min的平均动脉压和心率,间歇正压通气15 min时和气腹15 min时的气道峰压(Ppeak)、潮气量(VT)和呼气末CO2分压(PETCO2)。结果两组的插管时间、间歇正压通气15 min时和气腹15 min时的Ppeak、VT、PETCO2差异无统计学意义(P>0.05)。两组首次插管后通气成功率均为95%,纤维支气管镜确认PLMA首次正确到位率为87.5%。PLMA组插管时、插管后3 min、拔管时和拔管后3 min的平均动脉压和心率较TT组降低(P<0.05或0.01)。拔管时TT组65%出现呛咳或挣扎反应,术后2、24 h咽痛发生率分别为22.5%、25%,而PLMA组均无拔管反应和术后咽痛。结论与气管导管相比,双管型喉罩操作简便,应激反应小,通气可靠,可避免术后咽喉部并发症。

Objective To investigate the possibility of using LMA-ProSeal （PLMA） instead of endotracheal intubation for mechanical ventilation during laparoscopic biliary tract operation. Methods Eighty ASAⅠ or Ⅱ patients aged 21-63 yr undergoing laparoscopic surgery were enrolled in the study. The extent of mouth opening and extension of the atlanto-occipital joint as well as the visibility of facial pillars, uvula and soft palate （Mallampati class Ⅰ or Ⅱ ） of these patients were normal. The patients were randomized to receive either PLMA （ n = 40） or endotracheal tube （ n = 40）. Anesthesia was induced with propofol 2 mg· kg^- 1 , sufentanil 0.6 μg· kg^-1 and atracurium 0.6 mg· kg^-1 . PLMA insertion and endotracheal intubation were performed by the same highly experienced anesthesiologist. The number of attempts at insertion and success rate, time of insertion, BP and HR before, during and after insertion and removal were recorded. The adequacy of ventilation was estimated by peak inspiratory airway pressure （Ppeak）, tidal volume （VT） and PETCO2. The position of PLMA was examined by fiberoptic bronchoscopy. Results There was no significant difference in time of insertion, Ppeak, VT and PETCO2 at 15 min of IPPV or peritoneal insufflation between the two groups （P 〉 0.05）. The success rate of insertion at first attempt was similar （95%） in both groups. PLMA was placed in the correct position in 87.5% of the patients. The changes in BP and HR and the extubation or PLMA removal response were less in the PLMA group. Significantly less patients in PLMA group complained about sore throat after operation （P 〈 0.01 ）. Conclusion PLMA is superior to endotracheal intubation in terms of ease of insertion, intubation or insertion response and extubation or removal response, efficacy of mechanical ventilation and postoperative sore throat.