SLIPA喉罩与气管插管麻醉在腹腔镜胆囊切除手术的应用比较

Compare with application of SLIPA larygneal mask and tracheal intubation to iaparoscopic cholecystectomy

目的比较SLIPA喉罩与气管插管全麻对腹腔镜胆囊切除手术患者循环和呼吸参数的变化及并发症的情况，探讨相应的护理方法。方法60例择期腹腔镜胆囊切除手术患者随机分为SLIPA喉罩组和气管插管组，记录两组患者插管前后心率、血压、每分通气量（MV）、潮气量（TV）、气道峰压（Ppeak）和呼吸末二氧化碳分压（PETCO：）；观察术中反流误吸，术毕呛咳，术后咽痛、声音嘶哑、恶心、呕吐、肺部感染等发生率。结果两组患者正压通气15min和气腹15min时MV、TV、Ppeak、PETCO2均有明显改变，SLIPA喉罩组术后发症发生率低于气管插管组。结论SLIPA喉罩通气用于开腹腔镜胆囊切除手术优于气管插管，易于维持血流动力学稳定，并发症低。喉罩组患者护理侧重于术前护理评估及防止术中移位，气管插管患者护理侧重气管护理及预防感染等并发症的发生。

Objective To compare the changes of circulation and respiration parameters and the complications of the patients undergoing laparoscopic cholecystectomy with SLIPA larygneal mask and tracheal intubation, and explore appropriate methods of nursing care for it. Methods A total of 60 patients undergoing laparoscopic cholecystectomy were randomly allocated into two groups ： SLIPA group （ n = 30 ） and tracheal intubation group （ n = 30 ）. Two groups of patients with intubation were recorded before and after intubation in terms of HR, SBP, DSP, and the minute ventilation, tidal volume, peak airway pressure （Ppeak）, PETCO2. The incidence of complications such as reflux and aspiration in the operation, bucking when the operation finished, sore throat, hoarseness, nausea, vomiting, lung infection after operation and were observed. Results The minute ventilation （MV）, tidal volume （TV）, peak airway pressure （Ppeak）, and PETCO2 at 15 minute after positive pressure ventilation and pneumoperitoneum were significantly different between the two groups. The incidence of postoperative complications of SLIPA（ group L） was significantly lower than that of tracheal intubation group. Conclusions SLIPA laryngeal mask airway for laparoscopic cholecystectomy is superior to tracheal intubation. It can maintain hemodynamic stable and low complications. Nursing care on patients used laryngeal mask anesthesia and tracheal intubation have different emphases, the former focused on the preoperative nursing assessment and prevention of intraoperative displacement, and the latter focused on tracheal nursing care and prevention of infection and other complications.