i—gel喉罩用于腹腔镜胆囊手术患者气道管理的效果

Efficacy of laryngeal mask airway i-gel in patients undergoing laparoscopic cholecystectomy

目的评价i—gel喉罩用于腹腔镜胆囊手术患者气道管理的效果。方法择期全麻下拟行腹腔镜胆囊手术患者120例，性别不限，ASA分级I或Ⅱ级，年龄34～62岁，体重45—90咄，随机分为2组（n=60）：ProSeal喉罩组（P组）和i-gel喉罩组（I组）。根据体重选择喉罩型号，麻醉诱导后置入喉罩，行机械通气，并经引流管放置胃管。记录喉罩置入次数、喉罩及胃管置入情况、纤支镜检查评分，测定喉罩密封压，观察术中口咽部漏气、低氧血症的发生情况。术中监测Sp02、PET CO2、气道峰压，观察拔除喉罩后恶心、呕吐、呛咳、声嘶、咽喉痛、返流误吸的发生情况，记录麻醉时间、手术时间、拔除喉罩时间及苏醒时间。结果两组麻醉时间、手术时间、拔除喉罩时间及苏醒时间差异无统计学意义（P〉0．05）。两组术中SpO2、PET CO2、气道峰压均在正常范围内。与P组比较，I组喉罩首次置入成功率和纤支镜检查评分升高，喉罩置入时间缩短（P〈0．05）。两组喉罩和胃管置入成功率均为100％；I组和P组喉罩密封压比较差异无统计学意义（P〉0．05）；I组咽喉痛发生率低于P组（P〈0．05），恶心呕吐、呛咳发生率差异无统计学意义（P〉0．05），两组无一例发生声嘶、返流误吸。结论i-gel喉罩易于置入，气道密封性可靠，通气效果好，不良反应少，可安全有效地用于腹腔镜胆囊手术患者的气道管理。

Objective To assess the efficacy of the laryngeal mask airway i-gel （LMA i-gel） in patients undergoing laparoscopic cholecystectomy. Methods One hundred and twenty ASA I or II patients of both sexes, aged 34-62 yr, weighing 45-90 kg, undergoing elective cholecystectomy using fiberoptic laparoscope, were randomized into 2 groups （n = 60 each）： LMA i-gel group （group I） and LMA ProSeal group （group P）. After induction of anesthesia with sufentanil 0.2 ug/kg, propofol 2.5 mg/kg and vecuronium 0.1 mg/kg, LMA i-gel and LMA ProSeal were inserted in group I and P respectively. A gastric tube was inserted through the drain tube of the LMAs. The number of attempts, success rate, success rate of gastric tube placement, airway seal pressure, SpO2, PET CO2, peak airway pressure and complications （hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents） were recorded. The fiberoptic laryngoscope seores were assessed after sccessful LMA placement. The anesthesia time, duration of surgery, extubation time and emergence time were also recorded. Results There was no significant difference in the anesthesia time, duration of surgery, extuhation time and emergence time between the two groups （P 〉 0.05）. The SpO2, PET CO2 and peak airway pressure were within the normal range during operation in both groups. The first attempt success rate of LMA placement and fiberoptic bronchoscopic scores were significantly higher, and the LMA placement time was significantly shorter in group I than in group P （P 〈 0.05）. The success rate of LMA and gastric tube placement was 100% in both groups. The incidence of sore throat was significantly lower in group I than in group P （ P 〈 0.05 ）. Conclusion LMA i-gel can provide adequate ventilation during operation with less complications and can be used effectively for cholecystic laparoscopic surgery.