喉管与双管喉罩和气管插管在全麻中应用的效果比较

Comparison of clinical efficacy through the laryngeal tube,proseal laryngeal mask airway and endotracheal during genenal anesthesia

目的比较喉管与双管喉罩和气管插管在全麻中应用的效果。方法择期全子宫切除术全麻患者60例,ASAⅠ-Ⅱ级,随机分为3组(n=20),喉管组(L组)、双管喉罩组(P组)和气管插管组(T组)。诱导待肌松完全后插入适宜型号的喉管或双管喉罩或气管导管。记录插入时间、一次插入成功率和气道峰压;监测麻醉诱导前(Ta)、手术进行30min(Tb)和60 min(Tc)时的动脉血氧分压(PO2)和二氧化碳分压(PCO2);记录基础(T0)、插入前即刻(T1)、插入后1min(T2)、3 min(T3)、5 min(T4)及拔除前即刻(T5)、拔除后1 min(T6)、3 min(T7)、5 min(T8)的血流动力学指标,持续观察手术期间的脉搏血氧饱和度(SpO2);观察术后24 h内出现的相关并发症。结果L组的插入时间与P组和T组相比稍长,而一次插入成功率则较低;三组患者的气道峰压均在正常范围内且差异无统计学意义(P>0.05)。三组患者各时点的PO2、PCO2差异无统计学意义(P>0.05);三组患者的血流动力学在插管(罩)期或拔管(罩)期,T组明显升高(P<0.05),L组和P组无明显变化(P>0.05),且L组或P组与T组差异有统计学意义(P<0.05),三组患者的SpO2差异无统计学意义;T组有2例患者出现咽痛,而L组和P组无任何术后并发症。结论喉管可以安全地应用于全麻中,且通气效果与双管喉罩和气管插管比较无差异;在维持血流动力学平稳、减少术后并发症方面喉管则要优于气管插管;但插入所需的时间较长,一次插入成功率却较低。

Objective To compare the clinical efficacy through the laryngeal airway（PLMA） and endotracheal （ET） during genenal anesthesia. Methods tube （ LT）, proseal laryngeal mask Sixty ASA Ⅰ - Ⅱ patients undergoing elective gynecological hysterectomia surgery were randomized into 3 groups ： group Ⅰ LT, group Ⅱ PLMA and group Ⅲ ET. LT, PLMA and ET were inserted when muscles were completely relaxed after anesthesia induction. The insertion time, the successful insertion rate at first attempt, peak airway pressures were recorded. PO2 and PCO2 were monitored at before anesthesia induction,at 30,60 min after ded at before anesthesia induction immediately, before extubation immediately, at 1,3, 5 min The pharyngeal adverse responses at 24 h after beginning operation. SBP, DBP, MAP, HR were recorbefore insertion immediately, at 1, 3, 5 min after insertion and at after extubation. SpO2 was continuously recored during anesthesia. operation were recored. Results The insertion time of the group L was longer than group P and group T, but the successful insertion rate at first attempt of the group L was lower than group P and group T. The peak airway pressures of the there groups were within normal limits and comparable ; The PO2 、PCO2 of the three groups were comparable. SBP, DBP, MAP and HR in group T were significantly increased whether insertion or extubation, which were not in group L and group P, the difference of group L or group P compared to group T had statistical significance （ P 〈 0. 05 ）. SpO2 of the three groups were comparable. Group T had two cases of sore throat postoperatively while group L and group P had no. Conclusion Laryngeal tube can be safely used in genenal anesthesia, there is no difference in ventilatory effects in the there groups, LT is better in keeping stable hemodynamics and producing less pharyngeal adverse responses than ET;but the insertion time of LT is longer, and the successful insertion rate at first attempt is lower.