喉罩在腹腔镜下胆囊切除术的临床应用

Clinical Application of LMA During LC （laparoscopic cholecystectomy）

目的：喉罩（LMA）作为声门上通气装置．是近二十年来气道维持中最重要的发明。近年来喉罩已广泛应用于全麻中。替代了气管插管。本文探讨喉罩在腹腔镜下胆囊切除术中的应用。方法：选择腹腔镜下胆囊切除病人（ASAⅠ～Ⅱ）100例．并随机分为喉罩组（V组）50例和气管插管组（C组）50例。两组病人术前均肌注阿托晶、鲁米那，入室后开放静脉，麻醉诱导用咪唑安定、芬太尼、维库溴铵、异丙酚．肌松后V组放入喉罩．C组插入气管导管．麻醉维持两组均泵入异丙酚，静注芬太尼和维库溴铵。结果：V组麻醉3min后病人MBP、HR无明显改变，而C组MBP升高、HR增快,CO2气腹后10min．20min较气腹前呼末二氧化碳分压（PET CO2）明显升高．SPO2无明显变化。结论：喉罩全麻是腹腔镜下胆囊切除术的选择之一。

Objective： LMA applied as supraglottis device is one of the most important invention for the last 20 years. LMA has been widely used in general anaesthesia, and taken the place of endotracheal intubation recently. Here we will discuss the LMA usage during the LC. Method： One hundred patients （ASA Ⅰ～Ⅱ） were randomly allocated into LMA group （group V） or endotracheal intubation group （group C） （n=50）. Preoperative medication included Atropin and Luminal given intramuscularly. Anaesthesia induction with Midazolum, Fentanyl, Vecuronium and Propofol intravenously. After muscle relaxation, LMA in group V and endotracheal tube in group C were placed under facilitied conditions. Anaesthesia maintainence included propofol, fentanyl and vecuronium given intravenously. Result： MBP, HR did not change evidently in group V 3minutes after anaesthesia, while MBP, HR increased and PETCO2 evidently elevated after Carbondioxide-Pneumoperitoneum for 10 and 20minunes in group C. SPO2 did not change evidently. Concision： LMA anaesthesia is one of the choices for LC.