SLIPA喉罩和气管插管全麻在腹腔镜胆囊手术中的应用比较

Comparison of SLIPA laryngeal mask airway and endotreacheal intubation in the laparoscopic cholecystectomy under general anesthesia

目的观察SLIPA喉罩与气管插管对患者血流动力学和气道阻力的影响。方法择期全麻下腹腔镜胆囊手术患者60例,随机均分为SLIPA喉罩组(A组)和气管插管组(B组),记录插入喉罩/气管导管前(T0)、插入喉罩/气管导管后1min(T1)、3min(T2)和拔喉罩/气管导管前(T3)、拔喉罩/气管导管后1min(T4)、3min(T5)的SBP、DBP、HR和SpO2,同时在8ml/kg潮气量下监测T1～T3时的平均气道压(Pmean)、气道峰压(Ppeak)和PETCO2,并观察有无反流误吸情况及术后咽喉部并发症。结果与T0时相比,B组T1、T3、T4时SBP、DBP明显升高,HR明显增快,且相应时点均高于A组(P<0.05);A组在T1、T2时的Pmean、Ppeak低于B组(P<0.05);术后咽部不适患者B组(9例)明显多于A组(2例)(P<0.05)。结论 SLIPA喉罩通气用于腹腔镜胆囊手术时,患者应激反应小,术后咽喉部并发症少。

Objective To observe the effects of SLIPA laryngeal mask airway and endotreacheal intubation on hemodynamics and airway resistance.Methods Sixty general anesthesia patients scheduled for selective laparoscopic cholecystectomy were randomized into two groups with 30 cases each：SLIPA（A）group and endotreacheal intubation（B）group.SBP,DBP,HR and SpO2 were recorded at 6 time pionts：before intubation（T0）,1 min（T1）,3 min（T2）after intubation,before extubation（T3）,1 min（T4）,3 min（T5）after extubation.Pmean,Ppeak and PETCO2 were measured at T1-T3 under the tidal volume in 8 ml/kg respectively.And to observe the availability of intraoperative aspiration of reflux and postoperative throat complications.Results In group B,SBP,DBP and HR at T1,T3,T4 were higher than at T0 and at the same time points in group A（P〈0.05）;Pmean and Ppeak were lower in group A than those in group B at T1 and T2（P〈0.05）;The cases of postoperative throat discomfort in group B（9 cases）are more than in group A（2 cases）（P〈0.05）.Conclusion SLIPA laryngeal mask airway induced less stress reaction and had fewer complications of throat after operation in patients undergoing laparoscopic cholecystectomy.