第三代喉罩在全麻腹腔镜胆囊切除术中的应用

Clinical application of LMA ProSealTM to laparoscopic cholecystectomy under general anesthesia

目的通过观察患者循环和呼吸参数变化及并发症情况,探讨第三代喉罩(PLMA)在腹腔镜胆囊切除术中应用的安全性。方法60例择期腹腔镜胆囊切除术患者,随机分为气管插管全麻(ETT)、普通喉罩全麻(LMA)、第三代喉罩全麻(PLMA)三组;观测记录三组患者插管前、后1min的HR,SBP,DSP和正压通气15min和气腹15min时的分钟通气量(MV)、潮气量(TV)、气道峰压(Ppeak)和PETCO2;记录三组患者各种并发症发生例数。结果血流动力学改变表现为ETT组插管前、后有明显区别,插管后ETT组和LMA组、PLMA组间有明显区别;三组患者正压通气15min和气腹15min时的分钟通气量(MV)、潮气量(TV)、气道峰压(Ppeak)和PETCO2均有明显差异,组间无差异;LMA组胃肠道胀气严重,漏气例数比PLMA组明显增加。结论第三代喉罩适用于腹腔镜胆囊切除手术,安全有效,可避免气管插管和普通喉罩引起的并发症,值得推广应用。

Objective To explore the safety of applying LMA ProSealTM （PLMA） to laparoscopic cholecystectomy （LC） by observing the patients hemodynamic and respiratory indexes. Methods Sixty patients undergoing selective LC were randomly assigned to endotraeheal intubation （ETT） group, LMA group or PLMA group. Blood pressure （BP） and heart rate （HR） were recorded before induction of anesthesia and 1 minute after intubation or insertion of the LMA or PLMA. In addition, minute ventilation （MV）, tidal volume （TV）, peak airway pressure （Ppeak） and PETCO2 were recorded 15 minutes after pressure ventilation and pneumoperitoneum. The cases with the intra operational complications were also recorded. Results BP and HR were significantly increased after intubation than before induction in the ETT group. There were also significantly different in hemodynamic indexes among the three groups. MV, TV, Ppeak and PETCO2 were significantly different 15 minutes after pressure ventilation and pneumoperitoneum in the each group, but they were no different among the three groups. The patients in the LMA group have serious flatulence and the cases with airway leak were significantly increased in the LMA group than the PLMA group. Conclusion The application of PLMA to LC is safe and effective. It can avoid the intra operational complications which maybe caused by ETT or the LMA and should be spread accordingly.