妇科腹腔镜手术患者双管喉管和双管喉罩通气效果的比较

Comparison of ventilation through the laryngeal tube-suction airway and ProSeal laryngeal mask airway during gynecological laparoscopic surgery

目的比较双管喉管和双管喉罩用于妇科腹腔镜手术的通气效果。方法拟行妇科腹腔镜手术患者50例，ASAⅠ或Ⅱ级，体重指数〈30kg／m^2，随机分为2组（n=25），双管喉管组（L组）和双管喉罩组（P组）。两组均靶控输注异丙酚（血浆靶浓度3～5μg／ml）和瑞芬太尼（血浆靶浓度4～6ng／ml），静脉注射维库溴铵0．1mg／kg，待BISd0～60时置人适宜型号的双管喉管或双管喉罩，置人成功后应用纤维支气管镜观察口咽部解剖结构显露分级情况。记录双管喉管或双管喉罩置入时间、一次置人情况和气道密封压。术中持续监测HR、SP、DP、MAP、SpO2、气道峰压（Ppeak）和呼气末二氧化碳分压（PETCO2），记录手术时间、气腹时间、清醒时间、拔除时间及术后24h内咽部不良反应发生情况。结果两组置入时间、一次置入成功率、气道密封压、手术时间、气腹时间、清醒时间、拔除时间及术后24h内咽部不良反应发生率比较差异均无统计学意义（P〉0．05）。两组术中血液动力学平稳，SpO2、Ppeak和PETCO2均在正常范围，且差异无统计学意义（P〉0．05）。与L组比较，P组纤维支气管镜下口咽部解剖结构更清晰（P〈0．01）。结论双管喉管可有效地用于妇科腹腔镜手术，安全性良好，其通气效果与双管喉罩无差异。

Objective To compare the ventilation through the laryngeal tube-suction airway （LTSA） and ProSeal laryngeal mask airway （PLMA） during gynecological laparoscopic surgery. Methods Fifty ASA Ⅰ or Ⅱ patients （BMI 〈 30 kg/m^2） undergoing elective gynecological laparoscopic surgery were randomized into 2 groups （ n = 25 each） ： group I LTSA and group Ⅱ PLMA. Anesthesia was induced with TCI of propofol （ Cp = 3- 5 μg/ml） and remifentanyl TCI （Cp = 4-6 ng/ml） and iv vecuronium 0. 1 mg/kg. LTSA and PLMA were inserted when BIS was 40-60. Fiberoptic bronchoscopc scores were assessed （ Ⅰ = good ventilation, glottis and epiglottis are not visible; Ⅲ = good ventilation, glottis and epiglottis can be clearly seen） after successful insertion. The insertion time （from the beginning to the completion of insertion）, the rate of successful insertion at first attempt and airway seal pressure were recorded. HR, BP （SP, DP, MAP）, SpO2, peak airway pressure （Ppeak）and PETCO2 were continuously monitored and recorded before insertion at 1, 3, 5 min after insertion, at skin incision, 5, 10, 30 min of pneumoperitoneum and 3 min after pneumoperitoneum. The duration of operation and pneumoperitoneum, recovery time, extnbation time and pharyngeal adverse responses at 24 h after operation were recorded. Results The insertion time, the rate of successful insertion at first attempt, the duration of operation and pneumoperitoneum, recovery time and extubation, airway seal pressure and pharyngeal adverse responses at 24 h after operation were comparable between the 2 groups. The hemodynamics was stable during operation in both groups. SpO2, Ppeak and PETCO2 were within normal limits and comparable between the 2 groups. The fiberoptic bronchoscopic scores were significantly higher in group pLMA. Conclusion Both laryngeal tube-suction airway and ProSeal laryngeal mask airway can be safely and effectively used in gynecological laparoscopic surgery. There is no difference in ventilatory effects between the two groups.