全麻下喉罩在腹腔镜胆囊切除术中对正压通气的影响

The effects of using laryngeal mask airway under general anesthesia on positive pressure ventilation during celioscope cholecystectomy

目的：观察全麻下喉罩在腹腔镜胆囊切除术中对正压通气的影响。方法：择期腹腔镜胆囊切除手术病人60例，ASA I～Ⅱ级，随机分为喉罩组（I组，30例）和气管插管组（Ⅱ组，30例）。于麻醉诱导前、诱导后、插管（罩）后1min、气腹后5min、拔管（罩）后1min，监测并记录心率（HR）、平均动脉压（MAP）、气道峰压（Pmax）、气道平均压（Pmean）、脉搏血氧饱和度（SPO2）、呼气末二氧化碳分压（PETCO2）的数值，观察插管（罩）期、拔管（罩）期、术后24h咽痛及声嘶的发生率。结果：（1）插管（罩）期和拔管（罩）期Ⅱ组HR、MAP明显升高（P〈0．05），I组无明显变化（P〉0．05）。（2）2组PETCO2、Pmax、Pmean随麻醉、气腹的影响变化是一致的，组间比较各时间点差异无统计学意义（P〉0．05），2组SPO2均一直保持稳定。（3）Ⅱ组术后24h咽痛、声嘶发生率均明显高于I组（P〈0．05）。结论：腹腔镜胆囊切除手术中喉罩可以达到与气管插管一样满意的通气效果。

Objective： To evaluate the effects of using laryngeal mask airway（LMA） under general anesthesia on positive pressure ventilation during celioscopic cholecystectomy. Methods： Sixty ASA I-Ⅱ patients undergoing elective celioscope cholecystectomy were randomized into two groups： the laryngeal mask airway group （group I , n =30） and the tracheal intubation group （group Ⅱ , n =30）. We recorded the values of heart rate （HR）, mean arterial blood pressure （MAP）, maximal pressure of tracheal （Pmax）, mean pressure of tracheal （Pmean）, SPO2 , and pressure of end-tidal CO2 （PETCO2）at before and after induction anesthesia, after insert tracheal tube or LMA 1 min, after celiac puffing up 5 min, after pull out tracheal tube or LMA 1 min, respectively. The incidences of angina and trachyphonia were also recorded during insert tracheal tube or LMA, during pull out tracheal tube or LMA, and after operation 24 h as well. Results： （1） The values of HR and MAP in group Ⅱ were increased distinctly （P 〈0.05）, and in group I were not changed obviously （P 〉0.05）during insert tracheal tube or LMA and pull out tracheal tube or LMA. （2） PETCO2, Pmax and Pmean in two groups were accordingly changed during anesthesia and celiac puffing up. The discrepancy of intergroup was not significant at several time spots （P 〉0.05）. SPO2 in two groups were stable at all time spots. （3） After operation 24 h, the incidences of angina and trachyphonia in group Ⅱ were higher significantly than that in group I （P 〈0.05）. Conclusion： This study indicated that IrMA could attain satisfactorily ventilation effect as same as tracheal intubation under general anesthesia during celioscopic cholecystectomy.