喉罩在妇科腹腔镜手术不同气腹压力下通气效果的观察

Comparison of laryngeal mask airway in patients undergoing gynecological laparoscopy surgery with different intro-peritoneal pressure

目的探讨喉罩全麻通气在妇科腹腔镜手术中不同气腹压力下的安全性和有效性。方法 60例ASAⅠ～Ⅱ级腹腔镜卵巢肿瘤切除术患者常规全麻喉罩插管后,随机分成A组(n=20,气腹压力9mmHg组)、B组(n=20,气腹压力12mmHg组)和C组(n=20,气腹压力15mmHg组),记录并比较三组患者术中喉罩漏气、胃胀气、术后恶心呕吐和咽痛不良反应发生率,以及手术前气腹前(T1)、气腹后30min(T2)及术后15min(T3)的气道压力(Paw)、脉搏氧饱和度(SpO2)、呼气末二氧化碳分压(PetCO2)、平均动脉压(MAP)和心率(HR)的变化。结果和A、B组相比,C组术中喉罩漏气、术后恶心呕吐的发生率明显高于B组,差异有统计学意义(χ2分别=4.44、4.29,P均<0.05);C组在T2点的MAP、HR、Paw及PetCO2值均高于A、B两组,差异有统计学意义(F分别﹦5.67、6.23、4.30、5.25,P均<0.05)。结论经典型喉罩用于妇科腹腔镜手术中气腹压力维持12mmHg时通气效果良好,术中心血管应激反应小,术后咽痛发生率和恶心呕吐发生率低。

Objective To explore the safety,efficacy and side effect of classic laryngeal mask airway（LMA） in patients undergoing gynecological laparoscopy surgery with different intro-peritoneal pressure.Methods Sixty patients undergoing LMA general anesthesia for elective gynecological laparoscopy,ASA physical status I-Ⅱ,were randomly divided into three groups：group A（with 9 mmHg intro-peritoneal pressure）,group B（with 12 mmHg intro-peritoneal pressure） and group C（with 15mmHg intro-peritoneal pressure）.After anesthesia induction,changes of MAP and HR at T1,T2 and T3 points were observed.The peak airway pressure（Paw） and PetCO2 were monitored.Relevant perioperative side effects such as LMA leakage,gastric distention,PONV and sore throat were recorded.Results The incidence of LMA leakage and PONV in group C were significantly higher than those in group B.（χ2=4.44,4.29,P0.05）.HR,MAP,Paw and PetCO2 in group C were significantly increased at T2 point compared to those in group B and A（F=5.67,6.23,4.30,5.25,P 0.05）.Conclusions The classic LMA used for gynecological laparoscopy surgery with 12 mmHg intro-peritoneal pressure can provide a safer ventilation with less stress response and side effects than in those using 9 mmHg and 15 mmHg intro-peritoneal pressure.