全麻妇科腹腔镜手术喉罩通气道和气管插管的效果比较

Comparison of the Laryngeal Mask Airway and Endotracheal Intubation in the Gynaecological Laparoscopy Operation under General Anesthesia

目的:探讨喉罩通气道(LMA)用于妇科腹腔镜手术全麻中的安全性和可行性。方法:择期妇科腹腔镜手术患者50例,随机分为喉罩组(L组,n=25)和气管插管组(T组,n=25)。观察插管(罩)前后、术中气腹和拔管(罩)前后各时间点的平均动脉压(MAP)、心率(HR)、呼气末二氧化碳分压(P_(et)CO_2)、气道峰压(Paw)和肺顺应性(C_L)的变化;比较两组第1次置管成功率、术中漏气、胃膨胀程度和术后咽痛等情况。结果:T组导管插入、拔出后的MAP、HR均较其插入和拔出前明显升高(P＜0．05),L组则没有明显变化。气腹后两组P_(et)CO_2和Paw均较气腹前显著升高,C_L较气腹前明显降低,组间比较P_(et)CO_2、Paw、C_L无显著差异。两组第1次置管成功率、术中胃膨胀程度无明显差异。术中L组有4例出现轻度漏气,不影响呼吸管理。术后24h咽痛发生率及严重程度T组明显高于L组(P＜0．05)。结论:喉罩通气道较气管插管对患者生理功能影响小,术后并发症少,可安全用于妇科腹腔镜手术麻醉。

Objective：To observe the safety and efficacy of the laryngeal mask airway（LMA） in the gynaecological laparoscopy operation under general anesthesia. Methods： 50 patients with ASA Ⅰ - Ⅱ scheduled for gynaecological laparoscopy operation under general anesthesia were randomized into 2 groups , laryngeal mask group （N = 25）and endotracheal intubation（ETT） group （N = 25）. Mean arterial pressure（MAP）, heart rate（HR）, partial pressure of carbon dioxide in end expired gas （Po, CO2 ）, peak airway pressure（Paw） and lung compliance （CL） were measured before induction of anesthesia（T0 ） ,just before intubation（T1 ）, 1 min after intubation（T2 ）, 1 min before pneumoperitoneum（T3 ）, at 5 min（T4 ）, 15 min（T5 ）after pneumoperitoneum and 1 min after extubation（T6）. The rate of insertion at the first attempt , incidence and degree of airleak , gastric distention and sore throat were assessed （P^0.05）. Results： After intubation and extubation, MAP and HR increased significantly in group T（P〈0.05）, while group L had no significant change. After pneumoperitoneum, Pet CO2 and Paw increased signifi- cantly , CL was decreased in each group. Between group T and L PetCO2 , Paw and CL were not significan difference（P〈0. 05）. In group L, 4 patients leaked air during operation. The successful rate of insert at the first attempt and degree of change in gastric distention were similar in the two groups. The incidence and degree of sore throat in group T were significant higher than those in group L（P〈0.05）. Conclusion：There was less adverse effects of LMA than ETT under general anesthesia in the gynaecological laparoscopy operation , LMA was safe and efficacious.